Healthcare Provider Details

I. General information

NPI: 1891479945
Provider Name (Legal Business Name): MN UC PROVIDERS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13540 GROVE DR N
MAPLE GROVE MN
55311-4400
US

IV. Provider business mailing address

PO BOX 10417
HOLYOKE MA
01041-2017
US

V. Phone/Fax

Practice location:
  • Phone: 952-931-1276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMAS RANDALL STEVENS
Title or Position: CENTER DIRECTOR
Credential:
Phone: 952-931-1276