Full Name | |
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Speciality | Clinic/Center |
Location | 22 Elm St Nw, Clearbrook, Minnesota |
Authorized Official Name and Position | Tony Lee Morrison (VICE PRESIDENT, REVENUE CYCLE) |
Authorized Official Contact | 6053288380 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 5074 Sioux Falls SD 57117-5074 Ph: (605) 328-6585 | 22 Elm St Nw Clearbrook MN 56634 Ph: (218) 694-3124 |
NPI Number | 1457624272 |
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Provider Enumeration Date | 02/10/2012 |
Last Update Date | 11/27/2023 |
Medicare PECOS PAC ID | 5597725168 |
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Medicare Enrollment ID | O20120504000238 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457624272 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |