Healthcare Provider Details

I. General information

NPI: 1720162787
Provider Name (Legal Business Name): STARBUCK CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 POLER ST
STARBUCK MN
56381
US

IV. Provider business mailing address

PO BOX 460
STARBUCK MN
56381
US

V. Phone/Fax

Practice location:
  • Phone: 320-239-3939
  • Fax: 320-239-2802
Mailing address:
  • Phone: 320-239-3939
  • Fax: 320-239-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateMN

VIII. Authorized Official

Name: STEPHANI BLEHR
Title or Position: CERTIFIED PROFESSIONAL CODER BILLER
Credential: CPC
Phone: 320-239-3939