Provider Demographics
NPI:1619201449
Name:EZY URGENT CARE CLINIC, PLLC
Entity Type:Organization
Organization Name:EZY URGENT CARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-208-1871
Mailing Address - Street 1:1001 JOHNSON PKWY STE A1
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3655
Mailing Address - Country:US
Mailing Address - Phone:651-646-0028
Mailing Address - Fax:651-348-8638
Practice Address - Street 1:1001 JOHNSON PKWY STE A1
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-3655
Practice Address - Country:US
Practice Address - Phone:651-646-0028
Practice Address - Fax:651-348-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care