Provider Demographics
NPI:1144266156
Name:LAC QUI PARLE CLINIC OF MADISON INC
Entity type:Organization
Organization Name:LAC QUI PARLE CLINIC OF MADISON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BORGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-698-7152
Mailing Address - Street 1:900 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MN
Mailing Address - Zip Code:56256-1006
Mailing Address - Country:US
Mailing Address - Phone:320-598-7551
Mailing Address - Fax:320-598-7553
Practice Address - Street 1:820 3RD AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MN
Practice Address - Zip Code:56256-1014
Practice Address - Country:US
Practice Address - Phone:320-598-7551
Practice Address - Fax:320-598-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN106646OtherUCARE
MN3F739LAOtherBCBS
MN933813600Medicaid
MN933813600Medicaid