Full Name | |
---|---|
Speciality | Family Medicine |
Location | 300 Main Ave E, Frazee, Minnesota |
Authorized Official Name and Position | Tanner Goodrich (PRESIDENT) |
Authorized Official Contact | 2188475611 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1027 Washington Ave Detroit Lakes MN 56501-3409 Ph: (218) 334-7255 | 300 Main Ave E Frazee MN 56544 Ph: (218) 334-7255 |
NPI Number | 1275977928 |
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Provider Enumeration Date | 04/24/2013 |
Last Update Date | 10/01/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275977928 | NPI | - | NPPES |
892442000 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |