Provider Demographics
NPI:1699708396
Name:SOTERIA FAMILY HEALTH CENTER
Entity type:Organization
Organization Name:SOTERIA FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-577-2060
Mailing Address - Street 1:12805 HIGHWAY 55
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3859
Mailing Address - Country:US
Mailing Address - Phone:763-577-2060
Mailing Address - Fax:763-577-2099
Practice Address - Street 1:12805 HIGHWAY 55
Practice Address - Street 2:SUITE 111
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3859
Practice Address - Country:US
Practice Address - Phone:763-577-2060
Practice Address - Fax:763-577-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA02586Medicare UPIN