Provider Demographics
NPI:1679546477
Name:CENTRAL MINNESOTA EMERGENCY PHYSICIANS
Entity Type:Organization
Organization Name:CENTRAL MINNESOTA EMERGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-255-5657
Mailing Address - Street 1:1406 6TH AVE NO
Mailing Address - Street 2:
Mailing Address - City:ST. CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1901
Mailing Address - Country:US
Mailing Address - Phone:320-255-5657
Mailing Address - Fax:320-656-7194
Practice Address - Street 1:1406 6TH AVE NO
Practice Address - Street 2:
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1901
Practice Address - Country:US
Practice Address - Phone:320-255-5657
Practice Address - Fax:320-656-7194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN334207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN874013500Medicaid
MNC06895Medicare UPIN
MN874013500Medicaid