Provider Demographics
NPI:1033426069
Name:OLMSTED MEDICAL CENTER
Entity Type:Organization
Organization Name:OLMSTED MEDICAL CENTER
Other - Org Name:FASTCARE SOUTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-529-6610
Mailing Address - Street 1:90 14TH ST SW STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-3822
Mailing Address - Country:US
Mailing Address - Phone:507-280-1824
Mailing Address - Fax:
Practice Address - Street 1:90 14TH ST SW STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-3822
Practice Address - Country:US
Practice Address - Phone:507-280-1824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLMSTED MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-13
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center