Healthcare Provider Details

I. General information

NPI: 1407102882
Provider Name (Legal Business Name): EMERGENCY PHYSICIANS PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 DENMARK AVENUE
EAGAN MN
55121
US

IV. Provider business mailing address

4300 MARKETPOINTE DRIVE SUITE 100
BLOOMINGTON MN
55435-5435
US

V. Phone/Fax

Practice location:
  • Phone: 651-789-9900
  • Fax: 952-835-4403
Mailing address:
  • Phone: 952-835-9880
  • Fax: 952-857-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateMN

VIII. Authorized Official

Name: MS. KRISTI RENNICH
Title or Position: DIRECTOR, FINANCE
Credential:
Phone: 952-857-1501