| Hendricks Clinic | |
|
501 E Lincoln St Hendricks MN 56136-9598 | |
| (507) 275-3121 | |
| (507) 275-3194 |
| Full Name | Hendricks Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 501 E Lincoln St, Hendricks, Minnesota |
| Authorized Official Name and Position | Jeff Gollaher (CEO) |
| Authorized Official Contact | 5072753134 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hendricks Clinic 501 E Lincoln St Po Box 106 Hendricks MN 56136-9598 Ph: (507) 275-3134 | Hendricks Clinic 501 E Lincoln St Hendricks MN 56136-9598 Ph: (507) 275-3121 |
| NPI Number | 1013206812 |
|---|---|
| Provider Enumeration Date | 04/01/2011 |
| Last Update Date | 08/27/2012 |
| Medicare PECOS PAC ID | 9830127356 |
|---|---|
| Medicare Enrollment ID | O20110602000620 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013206812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Tabb D Mccluskey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952336828 PECOS PAC ID: 2365355146 Enrollment ID: I20040612000476 |
| Provider Name | Larry Jay Grong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871653758 PECOS PAC ID: 8123060217 Enrollment ID: I20050531000270 |
| Provider Name | Julie A Cameron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902800360 PECOS PAC ID: 6002880457 Enrollment ID: I20071101000715 |
| Provider Name | Debra Browning |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669407540 PECOS PAC ID: 0143499400 Enrollment ID: I20110803000503 |
| Provider Name | Grant W Eyjolfson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356655781 PECOS PAC ID: 0547410672 Enrollment ID: I20131018000556 |
| Provider Name | Tomasz P Lis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003122151 PECOS PAC ID: 8325273832 Enrollment ID: I20131108000055 |
| Provider Name | Kathryn Jo Christensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447709597 PECOS PAC ID: 9638458052 Enrollment ID: I20161108000035 |
| Provider Name | Kali S Manz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912677097 PECOS PAC ID: 7618360033 Enrollment ID: I20220208001534 |
Hendricks Clinic Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 E Lincoln St, Hendricks, MN 56136 Phone: 507-275-3121 Fax: 507-275-3194 |