Provider Demographics
NPI:1134468465
Name:EMERGENCY PHYSICIANS PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:EMERGENCY PHYSICIANS PROFESSIONAL ASSOCIATION
Other - Org Name:THE URGENCY ROOM - VADNAIS HEIGHTS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-857-1501
Mailing Address - Street 1:4300 MARKETPOINTE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5435
Mailing Address - Country:US
Mailing Address - Phone:952-835-9880
Mailing Address - Fax:952-857-1554
Practice Address - Street 1:1159 E. COUNTY ROAD E
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55110
Practice Address - Country:US
Practice Address - Phone:651-789-6500
Practice Address - Fax:952-835-4403
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMERGENCY PHYSICIANS PROFESSIONAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-06
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7350369Medicaid