Eminence Healthcare LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

EMINENCE HEALTHCARE LLC

Practice address

150 Red Rock Rd
Newport, MN 55055-1830

Phone

(651) 358-9573

NPI assigned

Aug 6, 2024

Last updated

Aug 6, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Donnie Ray Wallace III

Title

Owner

Phone

(651) 358-9573

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1063242709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 RED ROCK RD",
            "city": "NEWPORT",
            "state": "MN",
            "postal_code": "550551830",
            "telephone_number": "651-358-9573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 RED ROCK RD",
            "city": "NEWPORT",
            "state": "MN",
            "postal_code": "550551830",
            "telephone_number": "651-358-9573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMINENCE HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "DONNIE",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-358-9573",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Newport, MN
• Providers in Newport, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.