=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144468448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHFIELD URGENT CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2009
-----------------------------------------------------
Last Update Date | 05/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2014 JEFFERSON RD STE C
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55057-3251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-664-9999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2014 JEFFERSON RD STE C
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55057-3251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-664-9999
-----------------------------------------------------
Fax | 507-664-3954
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR; PHYSICIAN PROVIDER
-----------------------------------------------------
Name | DR. KEVIN BARDWELL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 952-994-8530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | 36003
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------