| Valhalla Place Clinic, P.a. | |
|
6043 Hudson Rd Ste 220 Woodbury MN 55125-1033 | |
| (651) 925-8200 | |
| (652) 925-8201 |
| Full Name | Valhalla Place Clinic, P.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 6043 Hudson Rd Ste 220, Woodbury, Minnesota |
| Authorized Official Name and Position | Lynn Solem (OWNER) |
| Authorized Official Contact | 6519258200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Valhalla Place Clinic, P.a. 6043 Hudson Rd Ste 220 Woodbury MN 55125-1033 Ph: (651) 925-8200 | Valhalla Place Clinic, P.a. 6043 Hudson Rd Ste 220 Woodbury MN 55125-1033 Ph: (651) 925-8200 |
| NPI Number | 1780074849 |
|---|---|
| Provider Enumeration Date | 01/28/2015 |
| Last Update Date | 01/28/2015 |
| Medicare PECOS PAC ID | 7416259718 |
|---|---|
| Medicare Enrollment ID | O20160104001421 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780074849 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Minnesota) | Primary |
| Provider Name | Michelle M Murphy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972580058 PECOS PAC ID: 1759351448 Enrollment ID: I20040729000814 |
| Provider Name | Ernest W Lampe |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1023062783 PECOS PAC ID: 1951213370 Enrollment ID: I20050303000266 |
| Provider Name | Buddy Wayne Lile |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104858612 PECOS PAC ID: 4587658893 Enrollment ID: I20070316000218 |
| Provider Name | Lilian Kigonya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932375110 PECOS PAC ID: 4284788654 Enrollment ID: I20090819000562 |
| Provider Name | Victoria M Elmer |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1235192709 PECOS PAC ID: 7911181052 Enrollment ID: I20110413000868 |
| Provider Name | Lindsay J Fredricksen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104163989 PECOS PAC ID: 2961657705 Enrollment ID: I20130301000029 |
| Provider Name | Olalekan P Obadiya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265847149 PECOS PAC ID: 5496077885 Enrollment ID: I20141215001819 |
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