| Essentia Health St. Joseph's-pequot Lakes Clinic | |
|
4317 W Woodman St Pequot Lakes MN 56472-3473 | |
| (218) 568-4416 | |
| (218) 568-4625 |
| Full Name | Essentia Health St. Joseph's-pequot Lakes Clinic |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 4317 W Woodman St, Pequot Lakes, Minnesota |
| Authorized Official Name and Position | Kevin Boren (VP OF FINANCE) |
| Authorized Official Contact | 2187861009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Essentia Health St. Joseph's-pequot Lakes Clinic 4317 W Woodman St Pequot Lakes MN 56472-3473 Ph: (218) 568-4416 | Essentia Health St. Joseph's-pequot Lakes Clinic 4317 W Woodman St Pequot Lakes MN 56472-3473 Ph: (218) 568-4416 |
| NPI Number | 1730134891 |
|---|---|
| Provider Enumeration Date | 05/24/2006 |
| Last Update Date | 02/27/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730134891 | NPI | - | NPPES |
| 595013900 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 330736 (Minnesota) | Primary |