Healthcare Provider Details

I. General information

NPI: 1588158653
Provider Name (Legal Business Name): MINNESOTA VALLEY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S 4TH ST
LE SUEUR MN
56058-2203
US

IV. Provider business mailing address

6501 CITY WEST PKWY
EDEN PRAIRIE MN
55344-3248
US

V. Phone/Fax

Practice location:
  • Phone: 507-665-3375
  • Fax: 507-665-2191
Mailing address:
  • Phone: 952-653-2565
  • Fax: 952-653-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number45416
License Number StateMN

VIII. Authorized Official

Name: MICHAEL MEYERS
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 952-442-2191