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715 Delmore Dr Ste 100 Roseau MN 56751-1534 | |
(218) 463-1365 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 715 Delmore Dr, Roseau, Minnesota |
Authorized Official Name and Position | Catherine A Huss (CFO) |
Authorized Official Contact | 2184632500 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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715 Delmore Dr Roseau MN 56751-1599 Ph: (218) 463-2500 | 715 Delmore Dr Ste 100 Roseau MN 56751-1534 Ph: (218) 463-1365 |
NPI Number | 1225885676 |
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Provider Enumeration Date | 05/03/2024 |
Last Update Date | 06/18/2024 |
Medicare PECOS PAC ID | 4789586884 |
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Medicare Enrollment ID | O20240803000054 |
Identifier | Type | State | Issuer |
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1225885676 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Jack V, Lundbohm Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 317 2nd St Nw, Suite A, Roseau, MN 56751 Phone: 218-463-2992 Fax: 218-463-1229 |