Full Name | |
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Speciality | Clinic/Center |
Location | 1282 Walnut St, Dawson, Minnesota |
Authorized Official Name and Position | Sara Johnson (BUSINESS OFFICE) |
Authorized Official Contact | 3203122118 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1282 Walnut St Dawson MN 56232-2333 Ph: (320) 769-4393 | 1282 Walnut St Dawson MN 56232 Ph: (320) 769-4393 |
NPI Number | 1336145796 |
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Provider Enumeration Date | 06/21/2005 |
Last Update Date | 06/20/2018 |
Medicare PECOS PAC ID | 5395653836 |
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Medicare Enrollment ID | O20031103000231 |
Identifier | Type | State | Issuer |
---|---|---|---|
1336145796 | NPI | - | NPPES |
692320800 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Minnesota) | Primary |
Provider Name | Jessica M Mamer |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1831807874 PECOS PAC ID: 5991179459 Enrollment ID: I20230323001790 |