Healthcare Provider Details

I. General information

NPI: 1144266156
Provider Name (Legal Business Name): LAC QUI PARLE CLINIC OF MADISON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 3RD AVE
MADISON MN
56256-1014
US

IV. Provider business mailing address

900 2ND AVE
MADISON MN
56256-1006
US

V. Phone/Fax

Practice location:
  • Phone: 320-598-7551
  • Fax: 320-598-7553
Mailing address:
  • Phone: 320-598-7551
  • Fax: 320-598-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROL M BORGERSON
Title or Position: CFO
Credential:
Phone: 320-698-7152