| Same | |
|
626 Minnesota Ave Nw Bemidji MN 56601-3037 | |
| (218) 751-3280 | |
| Not Available |
| Full Name | Same |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 626 Minnesota Ave Nw, Bemidji, Minnesota |
| Authorized Official Name and Position | Kristi J. Miller (OFFICE MANAGER) |
| Authorized Official Contact | 2187513280 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Same 722 15th St Nw P.o. Box 640 Bemidji MN 56601-2528 Ph: (218) 751-3280 | Same 626 Minnesota Ave Nw Bemidji MN 56601-3037 Ph: (218) 751-3280 |
| NPI Number | 1598931792 |
|---|---|
| Provider Enumeration Date | 05/07/2008 |
| Last Update Date | 05/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598931792 | NPI | - | NPPES |
| 387142800 | Other | MN | CONSOLIDATED FUNDING |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1026450-1-CDT (Minnesota) | Primary |
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