Provider Demographics
NPI:1235297342
Name:RICHFIELD MEDICAL GROUP LTD
Entity Type:Organization
Organization Name:RICHFIELD MEDICAL GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NATE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORETTER-BUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:126-767-4736
Mailing Address - Street 1:6440 NICOLLET AVE SO
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423
Mailing Address - Country:US
Mailing Address - Phone:612-861-1622
Mailing Address - Fax:612-861-2307
Practice Address - Street 1:6440 NICOLLET AVE SO
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423
Practice Address - Country:US
Practice Address - Phone:612-861-1622
Practice Address - Fax:612-861-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN929208900Medicaid
MNC00277Medicare PIN
MN929208900Medicaid