Healthcare Provider Details

I. General information

NPI: 1255483764
Provider Name (Legal Business Name): RIDGEVIEW CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 2ND ST NE
NEW PRAGUE MN
56071-1709
US

IV. Provider business mailing address

301 2ND ST NE
NEW PRAGUE MN
56071-1709
US

V. Phone/Fax

Practice location:
  • Phone: 952-578-4431
  • Fax:
Mailing address:
  • Phone: 952-578-4431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25217
License Number StateMN

VIII. Authorized Official

Name: KRISTI BESSE
Title or Position: OPERATIONS MGR
Credential:
Phone: 952-495-2000