Provider Demographics
NPI:1801996129
Name:PARKVIEW CARE CENTER - ALBERT LEA MEDICAL CENTER
Entity type:Organization
Organization Name:PARKVIEW CARE CENTER - ALBERT LEA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-373-2384
Mailing Address - Street 1:55 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:MN
Mailing Address - Zip Code:56097-1814
Mailing Address - Country:US
Mailing Address - Phone:507-553-3115
Mailing Address - Fax:
Practice Address - Street 1:55 10TH ST SE
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:MN
Practice Address - Zip Code:56097-1814
Practice Address - Country:US
Practice Address - Phone:507-553-3115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBERT LEA MEDICAL CENTER MAYO HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN329923332BP3500X, 332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61845NAOtherBCBS
MN329542700Medicaid
MN329542700Medicaid