Provider Demographics
NPI:1124357983
Name:INJURY CARE
Entity Type:Organization
Organization Name:INJURY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MASH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-445-7890
Mailing Address - Street 1:12012 ORCHARD AVE W
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2842
Mailing Address - Country:US
Mailing Address - Phone:952-445-7890
Mailing Address - Fax:952-445-7893
Practice Address - Street 1:12012 ORCHARD AVE W
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2842
Practice Address - Country:US
Practice Address - Phone:952-445-7890
Practice Address - Fax:952-445-7893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1624261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center