Provider Demographics
NPI:1821202359
Name:PAYNESVILLE AREA HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PAYNESVILLE AREA HOSPITAL DISTRICT
Other - Org Name:GREEN LAKE 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 1:300 HIGHWAY 23
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SPICER
Mailing Address - State:MN
Mailing Address - Zip Code:56288-4607
Mailing Address - Country:US
Mailing Address - Phone:320-796-5555
Mailing Address - Fax:320-796-5558
Practice Address - Street 1:300 HIGHWAY 23
Practice Address - Street 2:SUITE 4
Practice Address - City:SPICER
Practice Address - State:MN
Practice Address - Zip Code:56288-4607
Practice Address - Country:US
Practice Address - Phone:320-796-5555
Practice Address - Fax:320-796-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital