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1656 Central St W Bagley MN 56621-4357 | |
(218) 694-2384 | |
(218) 694-6687 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1656 Central St W, Bagley, 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 | 1656 Central St W Bagley MN 56621-4357 Ph: (218) 694-2384 |
NPI Number | 1972875490 |
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Provider Enumeration Date | 01/30/2012 |
Last Update Date | 01/23/2025 |
Medicare PECOS PAC ID | 5597725168 |
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Medicare Enrollment ID | O20170921000215 |
Identifier | Type | State | Issuer |
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1972875490 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Heather Ann Czywczynski |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285920587 PECOS PAC ID: 1456529833 Enrollment ID: I20200629003242 |
Provider Name | Kalee Browne |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1215610621 PECOS PAC ID: 4688017338 Enrollment ID: I20240209000177 |
Provider Name | Kirsten Ruth Craft |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1093242646 PECOS PAC ID: 2466895180 Enrollment ID: I20240209002532 |