Provider Demographics
NPI: | 1922694561 |
---|---|
Name: | MINNESOTA VALLEY HEALTH CENTER INC |
Entity Type: | Organization |
Organization Name: | MINNESOTA VALLEY HEALTH CENTER INC |
Other - Org Name: | RIDGEVIEW LESUEUR CLINIC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT/CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PHELPS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 952-442-2191 |
Mailing Address - Street 1: | 621 S 4TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | LE SUEUR |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 56058-2203 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 621 S 4TH ST |
Practice Address - Street 2: | |
Practice Address - City: | LE SUEUR |
Practice Address - State: | MN |
Practice Address - Zip Code: | 56058-2203 |
Practice Address - Country: | US |
Practice Address - Phone: | 507-665-3375 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MINNESOTA VALLEY HEALTH CENTER INC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2020-12-17 |
Last Update Date: | 2022-04-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |