Healthcare Provider Details

I. General information

NPI: 1588764765
Provider Name (Legal Business Name): OSSEO CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 CENTRAL AVE
OSSEO MN
55369-1245
US

IV. Provider business mailing address

226 CENTRAL AVE
OSSEO MN
55369-1245
US

V. Phone/Fax

Practice location:
  • Phone: 763-425-2117
  • Fax: 763-425-3935
Mailing address:
  • Phone: 763-425-2117
  • Fax: 763-425-3935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANITA ANN KLATT
Title or Position: OFFICE MANAGER
Credential:
Phone: 763-425-2117