Provider Demographics
NPI:1437499019
Name:THE CLINIC LLC
Entity Type:Organization
Organization Name:THE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLBURN
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:218-640-2647
Mailing Address - Street 1:40734 COUNTY 1
Mailing Address - Street 2:
Mailing Address - City:BERTHA
Mailing Address - State:MN
Mailing Address - Zip Code:56437-1019
Mailing Address - Country:US
Mailing Address - Phone:218-640-2647
Mailing Address - Fax:218-461-4558
Practice Address - Street 1:210 JEFFERSON ST S
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1532
Practice Address - Country:US
Practice Address - Phone:218-640-2647
Practice Address - Fax:218-461-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1769683261QF0050X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical