Full Name | |
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Speciality | Clinic/Center |
Location | 225 Huseth St, Kenyon, Minnesota |
Authorized Official Name and Position | Eric Guth (CFO) |
Authorized Official Contact | 5076461416 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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225 Huseth St Kenyon MN 55946-1005 Ph: (507) 623-0123 | 225 Huseth St Kenyon MN 55946-1005 Ph: (507) 646-1000 |
NPI Number | 1518631407 |
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Provider Enumeration Date | 08/04/2021 |
Last Update Date | 12/13/2023 |
Medicare PECOS PAC ID | 2567372998 |
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Medicare Enrollment ID | O20220620001048 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518631407 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |