Provider Demographics
NPI:1922150432
Name:RIDGEVIEW CLINICS
Entity Type:Organization
Organization Name:RIDGEVIEW CLINICS
Other - Org Name:RIDGEVIEW DELANO CLINIC/WESTERN ORTHOPAEDICS & SPORTS MEDICINE CONSULT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-442-7890
Mailing Address - Street 1:916 SAINT PETER ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-2813
Mailing Address - Country:US
Mailing Address - Phone:763-972-9172
Mailing Address - Fax:763-972-9531
Practice Address - Street 1:916 SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-2813
Practice Address - Country:US
Practice Address - Phone:763-972-9172
Practice Address - Fax:763-972-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25217207Q00000X
MN19168207X00000X
MN9792363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN547427200Medicaid
MN547427200Medicaid
MN0384110002Medicare NSC