Healthcare Provider Details

I. General information

NPI: 1063818862
Provider Name (Legal Business Name): AFYA CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 3RD ST N
SAINT CLOUD MN
56303-4015
US

IV. Provider business mailing address

3850 KEYES ST
COLUMBIA HEIGHTS MN
55421-5033
US

V. Phone/Fax

Practice location:
  • Phone: 267-575-1293
  • 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: DR. EDRIS KOSAR
Title or Position: MANAGER
Credential: PHARMD
Phone: 267-575-1293