Provider Demographics
NPI:1275602955
Name:UNITY FAMILY HEALTHCARE
Entity Type:Organization
Organization Name:UNITY FAMILY HEALTHCARE
Other - Org Name:AVON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-631-5670
Mailing Address - Street 1:108 STRATFORD ST W
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MN
Mailing Address - Zip Code:56310-4506
Mailing Address - Country:US
Mailing Address - Phone:320-356-7602
Mailing Address - Fax:320-356-7891
Practice Address - Street 1:320 3RD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MN
Practice Address - Zip Code:56307-9363
Practice Address - Country:US
Practice Address - Phone:320-845-2157
Practice Address - Fax:320-845-6138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN176612100Medicaid
MN176612100Medicaid