Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 505 Main St, Henderson, Minnesota |
Authorized Official Name and Position | Michael Phelps (PRESIDENT/CEO) |
Authorized Official Contact | 9524422191 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
601 W Chandler St Arlington MN 55307 Ph: (507) 964-2271 | 505 Main St Henderson MN 56044 Ph: (507) 248-3433 |
NPI Number | 1841250255 |
---|---|
Provider Enumeration Date | 03/28/2006 |
Last Update Date | 04/20/2022 |
Medicare PECOS PAC ID | 3870722499 |
---|---|
Medicare Enrollment ID | O20140203000464 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841250255 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Minnesota) | Primary |