Provider Demographics
NPI:1437884830
Name:CORNER FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:CORNER FAMILY CLINIC LLC
Other - Org Name:CORNER FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WIRSIY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:952-356-9365
Mailing Address - Street 1:6603 QUEEN AVE S STE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2065
Mailing Address - Country:US
Mailing Address - Phone:612-450-4746
Mailing Address - Fax:612-249-7859
Practice Address - Street 1:6603 QUEEN AVE S STE S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2065
Practice Address - Country:US
Practice Address - Phone:612-450-4746
Practice Address - Fax:612-249-7859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center