Full Name | |
---|---|
Speciality | Clinic/center - Primary Care |
Location | 138 Main St S, Pierz, 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 |
---|---|
138 Main St S Pierz MN 56364-4400 Ph: (320) 468-2587 | 138 Main St S Pierz MN 56364-4400 Ph: (320) 468-2587 |
NPI Number | 1568418861 |
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Provider Enumeration Date | 05/26/2006 |
Last Update Date | 02/27/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568418861 | NPI | - | NPPES |
487312200 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 330736 (Minnesota) | Primary |