Provider Demographics
NPI:1053067520
Name:PIIC CLINICAL SERVICES
Entity type:Organization
Organization Name:PIIC CLINICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CARE OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALETHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-698-9860
Mailing Address - Street 1:323 WASHINGTON AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2206
Mailing Address - Country:US
Mailing Address - Phone:612-600-5586
Mailing Address - Fax:612-930-0106
Practice Address - Street 1:315 SAINT JULIEN ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-1875
Practice Address - Country:US
Practice Address - Phone:952-698-9860
Practice Address - Fax:833-972-1579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1710961156OtherNPI