1942674452 NPI number — NEW HORIZON URGENT CARE AND CLINIC LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942674452 NPI number — NEW HORIZON URGENT CARE AND CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HORIZON URGENT CARE AND CLINIC LLC
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:
1942674452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7809 SOUTHTOWN CTR
Provider Second Line Business Mailing Address:
SUITE 343
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55431-1324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-396-3762
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7809 SOUTHTOWN CTR
Provider Second Line Business Practice Location Address:
SUITE 343
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55431-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-396-3762
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ABDULLE
Authorized Official First Name:
MOHAMED
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
612-396-3762

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  827568000030 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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