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1103 1st St E Park Rapids MN 56470 | |
(218) 732-6300 | |
(218) 732-6370 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1103 1st St E, Park Rapids, Minnesota |
Authorized Official Name and Position | Alan James Hurley (COO) |
Authorized Official Contact | 7013647667 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1702 University Dr S Medical Staff Services-ssc Fargo ND 58103-4940 Ph: (701) 364-4222 | 1103 1st St E Park Rapids MN 56470 Ph: (218) 732-6300 |
NPI Number | 1730706656 |
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Provider Enumeration Date | 06/26/2020 |
Last Update Date | 03/01/2024 |
Medicare PECOS PAC ID | 2062326820 |
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Medicare Enrollment ID | O20200706000531 |
Identifier | Type | State | Issuer |
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1730706656 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Enlightenment Psychiatry Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1011 1st St E Ste 5, Park Rapids, MN 56470 Phone: 320-321-9599 Fax: 877-962-3624 | |