Provider Demographics
NPI:1538205208
Name:WRIGHT MEDICAL CARE PLLC
Entity type:Organization
Organization Name:WRIGHT MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:G
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-835-6465
Mailing Address - Street 1:PO BOX 398013
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-8013
Mailing Address - Country:US
Mailing Address - Phone:952-835-6465
Mailing Address - Fax:952-835-6423
Practice Address - Street 1:5422 CREEK VIEW LN
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-1310
Practice Address - Country:US
Practice Address - Phone:952-835-6465
Practice Address - Fax:952-835-6423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1265496095OtherPROVIDER NPI #
MN1790OtherREGISTRATION #
MNC05581OtherMEDICARE PTAN