Healthcare Provider Details

I. General information

NPI: 1669546628
Provider Name (Legal Business Name): LITTLE FALLS MEDICAL CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 2ND ST SE SUITE A
LITTLE FALLS MN
56345-3505
US

IV. Provider business mailing address

811 2ND ST SE SUITE A
LITTLE FALLS MN
56345-3505
US

V. Phone/Fax

Practice location:
  • Phone: 320-631-7200
  • Fax:
Mailing address:
  • Phone: 320-631-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number828
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number828
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number828
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number828
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number828
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number828
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number828
License Number StateMN

VIII. Authorized Official

Name: DR. PETER H GERMSCHEID
Title or Position: PRESIDENT
Credential: M.D.
Phone: 320-631-7200