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403 12th St N Wheaton MN 56296-1070 | |
(320) 563-8295 | |
(320) 563-8014 |
Full Name | |
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Speciality | Clinic/center |
Location | 403 12th St N, Wheaton, Minnesota |
Authorized Official Name and Position | Jim Wilkus (CEO) |
Authorized Official Contact | 2187392221 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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615 S Mill St Fergus Falls MN 56537-2756 Ph: (218) 739-2221 | 403 12th St N Wheaton MN 56296-1070 Ph: (320) 563-8295 |
NPI Number | 1619915543 |
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Provider Enumeration Date | 06/03/2006 |
Last Update Date | 08/17/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619915543 | NPI | - | NPPES |
109516 | Other | MN | WC UCARE # |
00-01587 | Other | MN | WC MEDICA # |
10344 | Medicaid | ND | |
62345FE | Other | MN | WC BCBS # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 44 (Minnesota) | Primary |