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105 Otter Drive Ottertail MN 56571-7040 | |
(218) 367-6111 | |
(218) 367-6110 |
Full Name | |
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Speciality | Family Medicine |
Location | 105 Otter Drive, Ottertail, Minnesota |
Authorized Official Name and Position | Martha K Leclerc (VP) |
Authorized Official Contact | 7012346248 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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720 4th St N Po Box 2010 Fargo ND 58122-0605 Ph: (218) 367-6111 | 105 Otter Drive Ottertail MN 56571-7040 Ph: (218) 367-6111 |
NPI Number | 1619900289 |
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Provider Enumeration Date | 07/08/2006 |
Last Update Date | 11/07/2011 |
Identifier | Type | State | Issuer |
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1619900289 | NPI | - | NPPES |
44100700 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |