Provider Demographics
NPI:1558413062
Name:RIDGEVIEW CLINICS
Entity Type:Organization
Organization Name:RIDGEVIEW CLINICS
Other - Org Name:RIDGEVIEW EXCELSIOR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
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 1:675 WATER ST
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-3063
Mailing Address - Country:US
Mailing Address - Phone:952-906-7855
Mailing Address - Fax:952-470-4523
Practice Address - Street 1:675 WATER ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-3063
Practice Address - Country:US
Practice Address - Phone:952-906-7855
Practice Address - Fax:952-470-4523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN769424500Medicaid
MN0384110007Medicare NSC
MN769424500Medicaid