Provider Demographics
NPI:1609981562
Name:WADENA MEDICAL CENTER, LTD
Entity Type:Organization
Organization Name:WADENA MEDICAL CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:YELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-631-1360
Mailing Address - Street 1:4 DEERWOOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1253
Mailing Address - Country:US
Mailing Address - Phone:218-631-1360
Mailing Address - Fax:218-631-7571
Practice Address - Street 1:4 DEERWOOD AVE NW
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1253
Practice Address - Country:US
Practice Address - Phone:218-631-1360
Practice Address - Fax:218-631-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN84151WAOtherBCBS OF MN
MNC08290Medicare ID - Type Unspecified