Provider Demographics
NPI:1144468448
Name:NORTHFIELD URGENT CARE LLC
Entity type:Organization
Organization Name:NORTHFIELD URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR; PHYSICIAN PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-994-8530
Mailing Address - Street 1:2014 JEFFERSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-3251
Mailing Address - Country:US
Mailing Address - Phone:507-664-9999
Mailing Address - Fax:507-664-3954
Practice Address - Street 1:2014 JEFFERSON RD STE C
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-3251
Practice Address - Country:US
Practice Address - Phone:507-664-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36003261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN204283500Medicaid
MN6348920001Medicare NSC
F43580Medicare UPIN