Provider Demographics
NPI:1407051154
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:952-442-7895
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:HOWARD LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55349-1007
Mailing Address - Country:US
Mailing Address - Phone:320-543-2591
Mailing Address - Fax:320-543-2693
Practice Address - Street 1:900 6TH ST
Practice Address - Street 2:
Practice Address - City:HOWARD LAKE
Practice Address - State:MN
Practice Address - Zip Code:55349-5647
Practice Address - Country:US
Practice Address - Phone:952-442-3190
Practice Address - Fax:952-442-3185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19168207X00000X
MN9792363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN673283600Medicaid
MN0384110006Medicare NSC
MNC02820Medicare ID - Type Unspecified