Provider Demographics
NPI:1851116685
Name:ENDGAME LLC
Entity type:Organization
Organization Name:ENDGAME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-224-7069
Mailing Address - Street 1:3508 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4578
Mailing Address - Country:US
Mailing Address - Phone:320-224-7069
Mailing Address - Fax:320-281-0093
Practice Address - Street 1:402 RED RIVER AVE N STE 3
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-1523
Practice Address - Country:US
Practice Address - Phone:320-685-8284
Practice Address - Fax:320-281-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center