Avera Medical Group Lake Benton | |
109 E Benton St Lake Benton MN 56149-1309 | |
(507) 368-4323 | |
(507) 368-4546 |
Full Name | Avera Medical Group Lake Benton |
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Speciality | Clinic/Center |
Location | 109 E Benton St, Lake Benton, Minnesota |
Authorized Official Name and Position | Debbie Streier (CEO) |
Authorized Official Contact | 5075379160 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Avera Medical Group Lake Benton 109 E Benton St Lake Benton MN 56149-1309 Ph: (507) 368-4323 | Avera Medical Group Lake Benton 109 E Benton St Lake Benton MN 56149-1309 Ph: (507) 368-4323 |
NPI Number | 1003869892 |
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Provider Enumeration Date | 05/19/2006 |
Last Update Date | 12/02/2022 |
Medicare PECOS PAC ID | 9638088537 |
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Medicare Enrollment ID | O20161129000531 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003869892 | NPI | - | NPPES |
9732144 | Medicaid | MN | |
5T014TY | Other | MN | BLUE CROSS BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |