Provider Demographics
NPI:1982779096
Name:DULCIMER MEDICAL CENTER PA
Entity Type:Organization
Organization Name:DULCIMER MEDICAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-238-4968
Mailing Address - Street 1:717 S STATE STREET
Mailing Address - Street 2:SUITE 900
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4969
Mailing Address - Country:US
Mailing Address - Phone:507-238-4968
Mailing Address - Fax:507-238-3377
Practice Address - Street 1:717 S STATE STREET
Practice Address - Street 2:SUITE 800
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4469
Practice Address - Country:US
Practice Address - Phone:507-238-4968
Practice Address - Fax:507-238-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN185458OtherUCARE
MN155H2DUOtherBCBS MN
MN185458OtherUCARE