Provider Demographics
NPI:1982630505
Name:CENTER FOR NATURAL MEDICINE PA
Entity Type:Organization
Organization Name:CENTER FOR NATURAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-452-6640
Mailing Address - Street 1:902 E 2ND ST
Mailing Address - Street 2:SUITE 327
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6354
Mailing Address - Country:US
Mailing Address - Phone:507-452-6640
Mailing Address - Fax:
Practice Address - Street 1:11800 SINGLETREE LN
Practice Address - Street 2:SUITE 310
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5328
Practice Address - Country:US
Practice Address - Phone:952-223-5669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3067261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center