Provider Demographics
NPI:1073638565
Name:FIRST CARE MEDICAL SERVICES
Entity Type:Organization
Organization Name:FIRST CARE MEDICAL SERVICES
Other - Org Name:ESSENTIA HEALTH FOSSTON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BODENSTEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-435-7633
Mailing Address - Street 1:900 HILLIGOSS BLVD SE
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-1542
Mailing Address - Country:US
Mailing Address - Phone:218-435-1133
Mailing Address - Fax:218-435-1134
Practice Address - Street 1:900 HILLIGOSS BLVD SE
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542-1542
Practice Address - Country:US
Practice Address - Phone:218-435-1133
Practice Address - Fax:218-435-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3901610OtherMEDICA GROUP #
MN0000452OtherMEDICA FOR MNCARE #
MN7T834FIOtherBLUE CROSS GROUP #
MN253K0FIOtherBLUE PLUS GROUP #
MN89020OtherHEALTHPARTNERS GROUP #
MN381347900Medicaid
MN3901610OtherMEDICA GROUP #
MNC06035Medicare PIN