1407051154 NPI number — RIDGEVIEW CLINICS

Table of content: (NPI 1407051154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407051154 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:
Provider Other Organization Name Type Code:
6
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:
1407051154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWARD LAKE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55349-1007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-543-2591
Provider Business Mailing Address Fax Number:
320-543-2693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWARD LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55349-5647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-442-3190
Provider Business Practice Location Address Fax Number:
952-442-3185
Provider Enumeration Date:
06/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BESSE
Authorized Official First Name:
KRISTI
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS & BUSINESS OFFICE MANAGE
Authorized Official Telephone Number:
952-442-7895

Provider Taxonomy Codes

  • 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: "Y" .
  • 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: 673283600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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