Provider Demographics
NPI:1013277789
Name:OLMSTED MEDICAL CENTER
Entity Type:Organization
Organization Name:OLMSTED MEDICAL CENTER
Other - Org Name:OMC SKYWAY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-529-6619
Mailing Address - Street 1:201 9TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-6768
Mailing Address - Country:US
Mailing Address - Phone:507-592-6616
Mailing Address - Fax:
Practice Address - Street 1:318 1ST AVE SW
Practice Address - Street 2:SUITE 203
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-3310
Practice Address - Country:US
Practice Address - Phone:507-529-6616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center