Provider Demographics
NPI:1720046071
Name:PAYNESVILLE AREA HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PAYNESVILLE AREA HOSPITAL DISTRICT
Other - Org Name:WATKINS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOBBE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-243-3767
Mailing Address - Street 1:150 CENTRAL AVE N
Mailing Address - Street 2:PO BOX 500
Mailing Address - City:WATKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55389-4505
Mailing Address - Country:US
Mailing Address - Phone:320-764-2630
Mailing Address - Fax:320-764-2640
Practice Address - Street 1:150 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:WATKINS
Practice Address - State:MN
Practice Address - Zip Code:55389-4505
Practice Address - Country:US
Practice Address - Phone:320-764-2630
Practice Address - Fax:320-764-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02719Medicare ID - Type Unspecified