Provider Demographics
NPI:1154490399
Name:URGENT MEDICINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:URGENT MEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-232-9000
Mailing Address - Street 1:2829 UNIVERSITY DR S
Mailing Address - Street 2:STE 101
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2829 UNIVERSITY DR S
Practice Address - Street 2:STE 101
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6050
Practice Address - Country:US
Practice Address - Phone:701-232-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN367119400Medicaid
ND12969Medicaid
MN367119400Medicaid