Provider Demographics
NPI:1790861649
Name:FIRST CARE MEDICAL SERVICES
Entity Type:Organization
Organization Name:FIRST CARE MEDICAL SERVICES
Other - Org Name:ESSENTIA HEALTH BAGLEY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BODENSTEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-435-7633
Mailing Address - Street 1:121 CENTRAL ST W
Mailing Address - Street 2:
Mailing Address - City:BAGLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56621-4393
Mailing Address - Country:US
Mailing Address - Phone:218-694-6281
Mailing Address - Fax:218-694-6283
Practice Address - Street 1:121 CENTRAL ST W
Practice Address - Street 2:
Practice Address - City:BAGLEY
Practice Address - State:MN
Practice Address - Zip Code:56621-4393
Practice Address - Country:US
Practice Address - Phone:218-694-6281
Practice Address - Fax:218-694-6283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN971428600Medicaid
MN243461Medicare Oscar/Certification
MN971428600Medicaid