1447204433 NPI number — URGENT CARE DOCTORS OFFICE, PA

Table of content: (NPI 1447204433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447204433 NPI number — URGENT CARE DOCTORS OFFICE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URGENT CARE DOCTORS OFFICE, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447204433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 PRAIRIE CENTER DR
Provider Second Line Business Mailing Address:
120
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-7328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-401-8290
Provider Business Mailing Address Fax Number:
952-401-8243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 PRAIRIE CENTER DR
Provider Second Line Business Practice Location Address:
120
Provider Business Practice Location Address City Name:
EDEN PRAIRIE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55344-7328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-401-8290
Provider Business Practice Location Address Fax Number:
952-401-8243
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
KATE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
952-401-8290

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22255 . This is a "AMERICAS PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 22420 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 414513500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6627123 . This is a "MEDICA HEALTH PLANS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 120793 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1M753CH . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1004730 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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