| Southern Cities Clinic | |
|
400 4th St Nw Faribault MN 55021-5031 | |
| (507) 384-6830 | |
| Not Available |
| Full Name | Southern Cities Clinic |
|---|---|
| Speciality | Dentist |
| Location | 400 4th St Nw, Faribault, Minnesota |
| Authorized Official Name and Position | Kimmerly Cardinal (ACCOUNTS RECEIVABLE SUPERVISOR) |
| Authorized Official Contact | 6514313693 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Cities Clinic Po Box 64979 Saint Paul MN 55164-0979 Ph: () - | Southern Cities Clinic 400 4th St Nw Faribault MN 55021-5031 Ph: (507) 384-6830 |
| NPI Number | 1437218740 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 11/09/2023 |
| Medicare PECOS PAC ID | 7517912991 |
|---|---|
| Medicare Enrollment ID | O20050318000140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437218740 | NPI | - | NPPES |
| 496053000 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | (* (Not Available)) | Primary |
| Provider Name | Carol J Peitzman |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1225120991 PECOS PAC ID: 9830148642 Enrollment ID: I20050119000754 |
| Provider Name | Peter S Miller |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1285734400 PECOS PAC ID: 3577609445 Enrollment ID: I20091006000720 |
| Provider Name | Abigail Porter Hestness Houts |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1700947173 PECOS PAC ID: 5799827184 Enrollment ID: I20100614000910 |
| Provider Name | Jean Teresa Larson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801257332 PECOS PAC ID: 6507163763 Enrollment ID: I20160404000028 |
| Provider Name | Bryan Ricardo Carleton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902201700 PECOS PAC ID: 3173847530 Enrollment ID: I20161212000003 |
| Provider Name | Frederick William Houts |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518152172 PECOS PAC ID: 7618161290 Enrollment ID: I20180416001493 |
| Provider Name | Kyleeann S Stevens |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427234475 PECOS PAC ID: 2466869508 Enrollment ID: I20210407002216 |
| Provider Name | Daniel O Moegi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508534751 PECOS PAC ID: 2264821610 Enrollment ID: I20211105001387 |
Nomeland Dental Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 412 Heritage Pl, Faribault, MN 55021 Phone: 507-334-7595 | |
Faribault Dental Care Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 417 Lincoln Ave Nw, Faribault, MN 55021 Phone: 507-332-7608 | |
King Orthodontics Ltd Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1575 20th St Nw, Suite 202, Faribault, MN 55021 Phone: 507-332-0022 Fax: 507-333-9553 | |
Midwest Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 412 Heritage Pl, Faribault, MN 55021 Phone: 507-334-7595 | |
Distinctive Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 417 Lincoln Ave Nw, Faribault, MN 55021 Phone: 507-332-8888 | |
Dr. Warren Johnson, Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 422 Heritage Place, Faribault, MN 55021 Phone: 507-334-5602 Fax: 507-334-3488 |