Organization
EMINENCE HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNIE RAY WALLACE III (OWNER)
(651) 358-9573
Entity
Organization
Contact information
Practice address
150 RED ROCK RD, NEWPORT, MN 55055-1830
(651) 358-9573
Mailing address
150 RED ROCK RD, NEWPORT, MN 55055-1830
(651) 358-9573
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
08/06/2024
Last updated
08/06/2024
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