Healthcare Provider Details

I. General information

NPI: 1609834944
Provider Name (Legal Business Name): MAPLE GROVE URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 ELM CREEK BLVD N
MAPLE GROVE MN
55369-7073
US

IV. Provider business mailing address

12000 ELM CREEK BLVD N
MAPLE GROVE MN
55369-7074
US

V. Phone/Fax

Practice location:
  • Phone: 763-420-7048
  • Fax: 763-420-7938
Mailing address:
  • Phone: 763-420-7048
  • Fax: 763-420-7938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. GRACE SABA
Title or Position: CLINIC MANAGER
Credential: RN
Phone: 763-420-7048