Provider Demographics
NPI:1972734721
Name:EMERGENCY PHYSICIANS PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:EMERGENCY PHYSICIANS PROFESSIONAL ASSOCIATION
Other - Org Name:THE URGENCY ROOM - WOODBURY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-857-1501
Mailing Address - Street 1:4300 MARKETPOINTE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5435
Mailing Address - Country:US
Mailing Address - Phone:953-835-9880
Mailing Address - Fax:952-857-1554
Practice Address - Street 1:7115 TAMARACK ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1208
Practice Address - Country:US
Practice Address - Phone:651-789-7000
Practice Address - Fax:952-835-4403
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMERGENCY PHYSICIANS PROFESSIONAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-28
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
MN261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7350369Medicaid