Provider Demographics
NPI:1861675159
Name:ROCHESTER CLINIC PLC
Entity Type:Organization
Organization Name:ROCHESTER CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENGYU
Authorized Official - Middle Name:
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:507-218-3095
Mailing Address - Street 1:3070 WELLNER DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-8427
Mailing Address - Country:US
Mailing Address - Phone:507-218-3095
Mailing Address - Fax:507-218-3097
Practice Address - Street 1:3070 WELLNER DR NE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-8427
Practice Address - Country:US
Practice Address - Phone:507-218-3095
Practice Address - Fax:507-218-3097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6476220001Medicare NSC
MNC05363Medicare UPIN