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300 3rd Avenue Se Suite 201-11 Rochester MN 55904 | |
(507) 216-3750 | |
(507) 776-5036 |
Full Name | |
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Speciality | Social Worker |
Location | 300 3rd Avenue Se, Rochester, Minnesota |
Authorized Official Name and Position | Brian Kenneth Flick (OWNER/PROVIDER/MENTAL HEALTH PROFES) |
Authorized Official Contact | 5072163750 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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P.o. Box 366 Pine Island MN 55963-0366 Ph: (507) 216-3750 | 300 3rd Avenue Se Suite 201-11 Rochester MN 55904 Ph: (507) 216-3750 |
NPI Number | 1821615147 |
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Provider Enumeration Date | 07/02/2020 |
Last Update Date | 01/31/2025 |
Certification Date | 07/02/2020 |
Medicare PECOS PAC ID | 8325465263 |
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Medicare Enrollment ID | O20200824003133 |
Identifier | Type | State | Issuer |
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1821615147 | NPI | - | NPPES |
6843956 | Other | MN | MN TAX ID |
14676192 | Other | CAQH |
Taxonomy | Type | License (State) | Status |
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1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Brian Flick |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1891248027 PECOS PAC ID: 6800180282 Enrollment ID: I20160808001686 |
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