Healthcare Provider Details

I. General information

NPI: 1942547096
Provider Name (Legal Business Name): BLAINE URGENCY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11855 ULYSSES ST NE
BLAINE MN
55434-3947
US

IV. Provider business mailing address

11855 ULYSSES ST NE
BLAINE MN
55434-3947
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-0911
  • Fax:
Mailing address:
  • Phone: 763-581-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY SPRATT
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 763-581-0911