Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 201 9th St W, Ada, Minnesota |
Authorized Official Name and Position | Alan Hurley (COO) |
Authorized Official Contact | 7013647667 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
201 9th St W Ada MN 56510-1279 Ph: (218) 784-5000 | 201 9th St W Ada MN 56510-1279 Ph: (218) 784-5000 |
NPI Number | 1366886186 |
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Provider Enumeration Date | 04/23/2013 |
Last Update Date | 02/29/2024 |
Medicare PECOS PAC ID | 4981659851 |
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Medicare Enrollment ID | O20050317000512 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366886186 | NPI | - | NPPES |
635141700 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |