Organization Active NPI

Central Medical Clinic PLLC

  • Pain Medicine Physician
  • Saint Paul, MN
National Provider Identifier
1174876643
Registry record updated Nov 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
37899 Issued in MN
Legal business name
CENTRAL MEDICAL CLINIC PLLC
Practice address
393 Dunlap St N
Suite LL34
Saint Paul, MN 55104-4200
Phone
(651) 644-6002
NPI assigned
Oct 22, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Alfonso Morales-Utrilla, M.D.
Title
Medical Director
Phone
(651) 644-6002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0000X 37899 MN Primary

Addresses

Primary practice location

393 Dunlap St N
Suite LL34
Saint Paul, MN 55104-4200

Mailing address

393 Dunlap St N
Suite LL34
Saint Paul, MN 55104-4200
Phone (651) 644-6002

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383264000000",
    "number": "1174876643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 DUNLAP ST N",
            "address_2": "SUITE LL34",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044200",
            "telephone_number": "651-644-6002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "393 DUNLAP ST N",
            "address_2": "SUITE LL34",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044200",
            "telephone_number": "651-644-6002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-22",
        "last_updated": "2013-11-01",
        "status": "A",
        "authorized_official_last_name": "MORALES-UTRILLA",
        "authorized_official_first_name": "ALFONSO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "651-644-6002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "MN",
            "license": "37899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.