Healthcare Provider Details

I. General information

NPI: 1023631041
Provider Name (Legal Business Name): BROWN CLINIC PLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 WALNUT ST
DAWSON MN
56232-2333
US

IV. Provider business mailing address

506 1ST AVE SE
WATERTOWN SD
57201-4499
US

V. Phone/Fax

Practice location:
  • Phone: 605-886-8482
  • Fax: 605-884-4300
Mailing address:
  • Phone: 605-886-8482
  • Fax: 605-884-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JIM VACHAL
Title or Position: CAO
Credential:
Phone: 605-884-4256