Cromwell Medical Clinic Pllc | |
5568 Clark Ave Ste 1 Cromwell MN 55726-5004 | |
(218) 644-3811 | |
(218) 644-3813 |
Full Name | Cromwell Medical Clinic Pllc |
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Speciality | Clinic/Center |
Location | 5568 Clark Ave Ste 1, Cromwell, Minnesota |
Authorized Official Name and Position | Shawn F Bode (SOLE MEMBER) |
Authorized Official Contact | 2184858123 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Cromwell Medical Clinic Pllc Po Box 116 Cromwell MN 55726-0116 Ph: (218) 485-8123 | Cromwell Medical Clinic Pllc 5568 Clark Ave Ste 1 Cromwell MN 55726-5004 Ph: (218) 644-3811 |
NPI Number | 1821250549 |
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Provider Enumeration Date | 06/25/2008 |
Last Update Date | 03/20/2023 |
Medicare PECOS PAC ID | 5890861173 |
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Medicare Enrollment ID | O20080910000613 |
Identifier | Type | State | Issuer |
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1821250549 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Faith A Manty |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1124218102 PECOS PAC ID: 0749375277 Enrollment ID: I20070928000384 |
Provider Name | Shawn F Bode |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1154324820 PECOS PAC ID: 6406768787 Enrollment ID: I20080910000600 |
Provider Name | Melissa Jean Herbranson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1124462080 PECOS PAC ID: 6406072776 Enrollment ID: I20140722001582 |
Gateway Family Health Clinic, Ltd. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5565 Hwy. 210, Cromwell, MN 55726 Phone: 218-644-3838 Fax: 218-644-3067 |