Provider Demographics
NPI:1609834944
Name:MAPLE GROVE URGENT CARE
Entity Type:Organization
Organization Name:MAPLE GROVE URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:SABA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:763-420-7048
Mailing Address - Street 1:12000 ELM CREEK BLVD N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7074
Mailing Address - Country:US
Mailing Address - Phone:763-420-7048
Mailing Address - Fax:763-420-7938
Practice Address - Street 1:12000 ELM CREEK BLVD N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7073
Practice Address - Country:US
Practice Address - Phone:763-420-7048
Practice Address - Fax:763-420-7938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
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
MN06042GROtherBLUE CROSS BLUE SHIELD
MN125487OtherUCARE/SENIOR
MN1004619OtherPREFERRED ONE
MN6619071OtherMEDICA CHOICE
MN=========OtherCIGNA
MN6619071OtherMEDICA CHOICE