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General NPI Number Information
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NPI Number | 1699708396
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Entity Type | Organization
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Legal Business Name | SOTERIA FAMILY HEALTH CENTER
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12805 HIGHWAY 55 SUITE 111
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City | PLYMOUTH
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State | MN
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Zip | 55441-3859
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Country | US
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Telephone | 763-577-2060
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Fax | 763-577-2099
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Provider Business Mailing Address
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Address Line | 12805 HIGHWAY 55 SUITE 111
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City | PLYMOUTH
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State | MN
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Zip | 55441-3859
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Country | US
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Telephone | 763-577-2060
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Fax | 763-577-2099
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | LORI FLEMMER
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Credential |
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Telephone | 763-577-2060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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