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?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty