Healthcare Provider Details

I. General information

NPI: 1215132972
Provider Name (Legal Business Name): RIDGEVIEW CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 SAINT PETER ST
DELANO MN
55328-2813
US

IV. Provider business mailing address

916 SAINT PETER ST
DELANO MN
55328-2813
US

V. Phone/Fax

Practice location:
  • Phone: 763-972-9172
  • Fax: 763-972-9531
Mailing address:
  • Phone: 763-972-9172
  • Fax: 763-972-9531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19168
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9792
License Number StateMN

VIII. Authorized Official

Name: KRISTI BESSE
Title or Position: OPERATIONS & BUSINESS OFFICE MANAGE
Credential:
Phone: 952-442-7895