Healthcare Provider Details

I. General information

NPI: 1629131461
Provider Name (Legal Business Name): RUM RIVER HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 1ST ST
PRINCETON MN
55371-1462
US

IV. Provider business mailing address

101 18TH AVE N
PRINCETON MN
55371-4756
US

V. Phone/Fax

Practice location:
  • Phone: 763-389-5080
  • Fax: 763-389-5453
Mailing address:
  • Phone: 763-389-5080
  • Fax: 763-631-9117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER JENSEN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 763-389-5080