Provider Demographics
NPI:1194877399
Name:LO MEDICAL CLINIC
Entity type:Organization
Organization Name:LO MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYKA
Authorized Official - Middle Name:
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-203-0040
Mailing Address - Street 1:2353 RICE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3721
Mailing Address - Country:US
Mailing Address - Phone:651-203-0040
Mailing Address - Fax:651-486-7594
Practice Address - Street 1:2353 RICE ST STE 210
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3721
Practice Address - Country:US
Practice Address - Phone:651-203-0040
Practice Address - Fax:651-486-7594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care