| Same | |
|
120 Main Ave N Park Rapids MN 56470-1810 | |
| (218) 732-7266 | |
| Not Available |
| Full Name | Same |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 120 Main Ave N, Park Rapids, 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 120 Main Ave N Park Rapids MN 56470-1810 Ph: (218) 732-7266 | Same 120 Main Ave N Park Rapids MN 56470-1810 Ph: (218) 732-7266 |
| NPI Number | 1073789269 |
|---|---|
| Provider Enumeration Date | 05/07/2008 |
| Last Update Date | 05/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073789269 | NPI | - | NPPES |
| 064997000 | Other | MN | CONSOLIDATED FUNDING |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1015165-1-CDT (Minnesota) | Primary |
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