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705 Pleasant Ave S Park Rapids MN 56470-1440 | |
(218) 732-2800 | |
(218) 732-2874 |
Full Name | |
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Speciality | Clinic/Center |
Location | 705 Pleasant Ave S, Park Rapids, Minnesota |
Authorized Official Name and Position | Alan James 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 |
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1027 Washington Ave Detroit Lakes MN 56501-3409 Ph: (218) 847-5611 | 705 Pleasant Ave S Park Rapids MN 56470-1440 Ph: (218) 732-2800 |
NPI Number | 1699955344 |
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Provider Enumeration Date | 11/10/2007 |
Last Update Date | 03/01/2024 |
Medicare PECOS PAC ID | 2062326820 |
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Medicare Enrollment ID | O20150420002236 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699955344 | NPI | - | NPPES |
800035000 | Medicaid | MN | |
14522 | Medicaid | ND |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Enlightenment Psychiatry Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1011 1st St E Ste 5, Park Rapids, MN 56470 Phone: 320-321-9599 Fax: 877-962-3624 | |