Provider Demographics
NPI:1376748400
Name:RIDGEVIEW CLINICS
Entity Type:Organization
Organization Name:RIDGEVIEW CLINICS
Other - Org Name:WESTERN ORTHOPAEDICS & SPORTS MEDICINE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS & BUSINESS OFFICE MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-442-7890
Mailing Address - Street 1:611 E FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-4213
Mailing Address - Country:US
Mailing Address - Phone:320-523-1261
Mailing Address - Fax:
Practice Address - Street 1:611 E FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-4213
Practice Address - Country:US
Practice Address - Phone:320-523-1261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19168207X00000X
MN9792363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC02820Medicare ID - Type Unspecified