| |
1400 W Saint Germain St Saint Cloud MN 56301-4101 | |
(320) 428-5697 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1400 W Saint Germain St, Saint Cloud, Minnesota |
Authorized Official Name and Position | Clayton Mallery White (BOARD CHAIR) |
Authorized Official Contact | 3202976800 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1400 W Saint Germain St Saint Cloud MN 56301-4101 Ph: (320) 429-5697 | 1400 W Saint Germain St Saint Cloud MN 56301-4101 Ph: (320) 428-5697 |
NPI Number | 1508638511 |
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Provider Enumeration Date | 10/23/2023 |
Last Update Date | 10/11/2024 |
Medicare PECOS PAC ID | 9133665201 |
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Medicare Enrollment ID | O20240725000222 |
Identifier | Type | State | Issuer |
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1508638511 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Rebecca J White |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1821345844 PECOS PAC ID: 5092965061 Enrollment ID: I20121029000339 |
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