Basic Information
| Provider Information | |||||||||
| NPI: | 1760651079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAPIDCARE URGENT CARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1517 32ND AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581035905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012326211 | ||||||||
| FaxNumber: | 7013649346 | ||||||||
| Practice Location | |||||||||
| Address1: | 1361 WENNER ROAD | ||||||||
| Address2: | |||||||||
| City: | DETROIT LAKES | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188469981 | ||||||||
| FaxNumber: | 2188468893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2008 | ||||||||
| LastUpdateDate: | 09/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7012326211 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RAPIDCARE URGENT CARE PLLC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 41391 | MN | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 510066600 | 05 | MN | MEDICAID |