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General NPI Number Information
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NPI Number | 1740798008
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Entity Type | Organization
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Legal Business Name | ACE MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 10259 ENGLEWOOD DR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55347-4623
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Country | US
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Telephone | 617-413-4952
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 44044
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-1044
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Country | US
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Telephone | 617-413-4952
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | REGINE W NDIFOR
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Credential | CNP RN
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Telephone | 617-413-4952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP0904X
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Taxonomy Name | Federal Public Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 3233
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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