|
| |
|
711 Delmore Dr Roseau MN 56751-1534 | |
| (218) 463-1365 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 711 Delmore Dr, Roseau, Minnesota |
| Authorized Official Name and Position | Derek Goebel (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7017801470 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
711 Delmore Dr Roseau MN 56751-1534 Ph: (218) 463-1635 | 711 Delmore Dr Roseau MN 56751-1534 Ph: (218) 463-1365 |
| NPI Number | 1770672289 |
|---|---|
| Provider Enumeration Date | 10/12/2006 |
| Last Update Date | 05/21/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770672289 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Jack V, Lundbohm Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 317 2nd St Nw, Suite A, Roseau, MN 56751 Phone: 218-463-2992 Fax: 218-463-1229 |