Provider Demographics
NPI:1659886505
Name:PIPE TRADE SERVICES FAMILY HEALTH
Entity Type:Organization
Organization Name:PIPE TRADE SERVICES FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-348-8851
Mailing Address - Street 1:930 BLUE GENTIAN RD STE 1000
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1675
Mailing Address - Country:US
Mailing Address - Phone:651-348-8851
Mailing Address - Fax:651-348-8853
Practice Address - Street 1:930 BLUE GENTIAN RD STE 1000
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1675
Practice Address - Country:US
Practice Address - Phone:651-348-8851
Practice Address - Fax:651-348-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty