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General NPI Number Information
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NPI Number | 1366628554
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Entity Type | Organization
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Legal Business Name | CRYSTAL NEW HOPE MEDICAL CLINIC INC
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Dates
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Enumeration Date | 01/17/2008
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 3501 DOUGLAS DR N
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City | CRYSTAL
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State | MN
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Zip | 55422-2415
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Country | US
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Telephone | 763-535-9601
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Fax | 763-535-5601
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Provider Business Mailing Address
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Address Line | 3501 DOUGLAS DR N
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City | CRYSTAL
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State | MN
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Zip | 55422-2415
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Country | US
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Telephone | 763-535-9601
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Fax | 763-535-5601
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ROXANNE M URBASHICH
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Credential |
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Telephone | 763-535-9601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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