Provider Demographics
NPI:1407560113
Name:ALABASTER HEALTHCARE LLC
Entity type:Organization
Organization Name:ALABASTER HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ESEOGHENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOKEDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-345-9900
Mailing Address - Street 1:1160 VIERLING DR E # 314
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4313
Mailing Address - Country:US
Mailing Address - Phone:612-345-9900
Mailing Address - Fax:612-345-9999
Practice Address - Street 1:2854 HIGHWAY 55 STE 130
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1447
Practice Address - Country:US
Practice Address - Phone:615-438-2711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care