Provider Demographics
NPI:1053608976
Name:NEW MED LLC
Entity type:Organization
Organization Name:NEW MED LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-440-0767
Mailing Address - Street 1:1702 17TH ST NW
Mailing Address - Street 2:STORE #6
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-6366
Mailing Address - Country:US
Mailing Address - Phone:507-440-0767
Mailing Address - Fax:
Practice Address - Street 1:1702 17TH ST NW
Practice Address - Street 2:STORE #6
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-6366
Practice Address - Country:US
Practice Address - Phone:507-440-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32355261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care