Provider Demographics
NPI:1316454077
Name:INDEPENDENT MEDICAL CLINIC PA
Entity type:Organization
Organization Name:INDEPENDENT MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:TOWNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-281-1298
Mailing Address - Street 1:2639 NICOLLET AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1629
Mailing Address - Country:US
Mailing Address - Phone:612-315-5145
Mailing Address - Fax:855-670-9121
Practice Address - Street 1:2639 NICOLLET AVE STE 120
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1629
Practice Address - Country:US
Practice Address - Phone:612-315-5145
Practice Address - Fax:855-670-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty