Provider Demographics
NPI:1750481958
Name:WEST CENTRAL INTERNAL MEDICINE
Entity Type:Organization
Organization Name:WEST CENTRAL INTERNAL MEDICINE
Other - Org Name:PRAIRIE MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:STOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-589-4008
Mailing Address - Street 1:24 E 7TH ST
Mailing Address - Street 2:PO BOX 410
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267-1312
Mailing Address - Country:US
Mailing Address - Phone:320-589-4008
Mailing Address - Fax:320-589-4227
Practice Address - Street 1:24 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1312
Practice Address - Country:US
Practice Address - Phone:320-589-4008
Practice Address - Fax:320-589-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5706872261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0836930001OtherDMERC CLINIC #
MN121703OtherUCARE CLINIC #
MN3T172WEOtherBLUE CROSS CLINIC #
MN30843OtherHEALTHPARTNERS CLINIC#
MNCN5505OtherRAILROAD MEDICARE #
MN121703OtherUCARE CLINIC #