Provider Demographics
NPI:1598725905
Name:SIBLEY MEDICAL CENTER
Entity Type:Organization
Organization Name:SIBLEY MEDICAL CENTER
Other - Org Name:RIDGEVIEW WINTHROP CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-442-2191
Mailing Address - Street 1:601 W CHANDLER ST
Mailing Address - Street 2:P.O. BOX 620
Mailing Address - City:ARLINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55307-2127
Mailing Address - Country:US
Mailing Address - Phone:507-964-2271
Mailing Address - Fax:507-964-8490
Practice Address - Street 1:202 SOUTH COUNTY ROAD 33
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MN
Practice Address - Zip Code:55396
Practice Address - Country:US
Practice Address - Phone:507-647-5318
Practice Address - Fax:507-647-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN248648200Medicaid
MN248648200Medicaid