Provider Demographics
NPI:1447204433
Name:URGENT CARE DOCTORS OFFICE, PA
Entity Type:Organization
Organization Name:URGENT CARE DOCTORS OFFICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-401-8290
Mailing Address - Street 1:800 PRAIRIE CENTER DR
Mailing Address - Street 2:120
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7328
Mailing Address - Country:US
Mailing Address - Phone:952-401-8290
Mailing Address - Fax:952-401-8243
Practice Address - Street 1:800 PRAIRIE CENTER DR
Practice Address - Street 2:120
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7328
Practice Address - Country:US
Practice Address - Phone:952-401-8290
Practice Address - Fax:952-401-8243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22255OtherAMERICAS PPO
MN22420OtherHEALTH PARTNERS
MN414513500Medicaid
MN6627123OtherMEDICA HEALTH PLANS
MN120793OtherUCARE
MN1M753CHOtherBLUE CROSS BLUE SHIELD
MN1004730OtherPREFERRED ONE
MN414513500Medicaid