Healthcare Provider Details

I. General information

NPI: 1205988714
Provider Name (Legal Business Name): RIDGEVIEW CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7907 POWERS BLVD
CHANHASSEN MN
55317-9502
US

IV. Provider business mailing address

7907 POWERS BLVD
CHANHASSEN MN
55317-9502
US

V. Phone/Fax

Practice location:
  • Phone: 952-934-0570
  • Fax: 952-906-7837
Mailing address:
  • Phone: 952-934-0570
  • Fax: 952-906-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number40131
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25217
License Number StateMN

VIII. Authorized Official

Name: MS. KRISTI L BESSE
Title or Position: OPERATIONS MGR
Credential:
Phone: 952-495-2000