Provider Demographics
NPI:1720162787
Name:STARBUCK CLINIC PLLC
Entity Type:Organization
Organization Name:STARBUCK CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROFESSIONAL CODER BILLER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEHR
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:320-239-3939
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:STARBUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56381
Mailing Address - Country:US
Mailing Address - Phone:320-239-3939
Mailing Address - Fax:320-239-2802
Practice Address - Street 1:501 POLER ST
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381
Practice Address - Country:US
Practice Address - Phone:320-239-3939
Practice Address - Fax:320-239-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN215R0STOtherBCBS
D75633Medicare UPIN
C03772Medicare ID - Type Unspecified