Provider Demographics
NPI:1336359009
Name:UNITY FAMILY HEALTHCARE
Entity Type:Organization
Organization Name:UNITY FAMILY HEALTHCARE
Other - Org Name:RANDALL LAKES AREA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-631-5670
Mailing Address - Street 1:250 WHITE OAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:RANDALL
Mailing Address - State:MN
Mailing Address - Zip Code:56475
Mailing Address - Country:US
Mailing Address - Phone:320-749-2877
Mailing Address - Fax:
Practice Address - Street 1:250 WHITE OAK DRIVE
Practice Address - Street 2:
Practice Address - City:RANDALL
Practice Address - State:MN
Practice Address - Zip Code:56475
Practice Address - Country:US
Practice Address - Phone:320-749-2877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITY FAMILY HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-23
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN640K9RAOtherBCBSM
MN040760700Medicaid
MN24-3447OtherRHC PROVIDER NUMBER
MN24-3447OtherRHC PROVIDER NUMBER
MNC06050Medicare PIN
MN243447Medicare Oscar/Certification