Healthcare Provider Details

I. General information

NPI: 1447204433
Provider Name (Legal Business Name): URGENT CARE DOCTORS OFFICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRAIRIE CENTER DR 120
EDEN PRAIRIE MN
55344-7328
US

IV. Provider business mailing address

800 PRAIRIE CENTER DR 120
EDEN PRAIRIE MN
55344-7328
US

V. Phone/Fax

Practice location:
  • Phone: 952-401-8290
  • Fax: 952-401-8243
Mailing address:
  • Phone: 952-401-8290
  • Fax: 952-401-8243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KATE YOUNG
Title or Position: BUSINESS MANAGER
Credential:
Phone: 952-401-8290