Healthcare Provider Details

I. General information

NPI: 1437163169
Provider Name (Legal Business Name): NEW SPIRIT WOMEN'S CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 SE 13TH ST
GRAND RAPIDS MN
55744-4257
US

IV. Provider business mailing address

3920 13TH AVE E SUITE 6
HIBBING MN
55746-3675
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-9100
  • Fax: 218-326-9200
Mailing address:
  • Phone: 218-263-7540
  • Fax: 866-732-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUE BURICH
Title or Position: OFFICE MANAGER
Credential:
Phone: 218-326-9100