1922150432 NPI number — RIDGEVIEW CLINICS

Table of content: (NPI 1922150432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922150432 NPI number — RIDGEVIEW CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIDGEVIEW CLINICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RIDGEVIEW DELANO CLINIC/WESTERN ORTHOPAEDICS & SPORTS MEDICINE CONSULT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922150432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
916 SAINT PETER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELANO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55328-2813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-972-9172
Provider Business Mailing Address Fax Number:
763-972-9531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
916 SAINT PETER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELANO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55328-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-972-9172
Provider Business Practice Location Address Fax Number:
763-972-9531
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BESSE
Authorized Official First Name:
KRISTI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
952-442-7890

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  25217 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 19168 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 9792 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 547427200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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