National Provider Identifier Database

PHOENIX
Voluntary or Charitable


Contact Information

PHOENIX
6697 ELM ST
NORTH BRANCH, MN55056-7045
Phone: 651-795-8759
Fax:
Website:
Specialty Taxonomy Code
* Voluntary or Charitable 251V00000X

* Indicates primary specialty

NPI Profile & details for PHOENIX

NPI Number 1972118438
Legal business name
LBN
PHOENIX
Authorized official JEREMY KORTUS - (CO-FOUNDER)
Entity Organization
Organization subpart No
Enumeration date 09/11/2020
Last updated 09/11/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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