Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 415 N 2nd St, Tower, Minnesota |
Authorized Official Name and Position | Michael A Holmes (CEO) |
Authorized Official Contact | 2183613127 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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20 5th St Se Cook MN 55723-9702 Ph: (218) 753-2405 | 415 N 2nd St Suite 2 Tower MN 55790 Ph: (218) 753-2405 |
NPI Number | 1750633806 |
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Provider Enumeration Date | 10/12/2012 |
Last Update Date | 11/19/2013 |
Medicare PECOS PAC ID | 4880681303 |
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Medicare Enrollment ID | O20130814000093 |
Identifier | Type | State | Issuer |
---|---|---|---|
1750633806 | NPI | - | NPPES |
1750633806 | Medicaid | MN | |
241865 | Other | MN | MEDICARE ID - TYPE UNSPECIFIED |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |