Provider Demographics
NPI:1821397803
Name:LINDAMAACHLLC
Entity Type:Organization
Organization Name:LINDAMAACHLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-920-8118
Mailing Address - Street 1:5200 WILLSON RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1332
Mailing Address - Country:US
Mailing Address - Phone:952-920-8118
Mailing Address - Fax:
Practice Address - Street 1:5200 WILLSON RD
Practice Address - Street 2:SUITE 405
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1332
Practice Address - Country:US
Practice Address - Phone:952-920-8118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN267999261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center