Healthcare Provider Details

I. General information

NPI: 1902833874
Provider Name (Legal Business Name): FIRSTSOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S BOUNDARY AVE
PROCTOR MN
55810-2306
US

IV. Provider business mailing address

211 S BOUNDARY AVE
PROCTOR MN
55810-2306
US

V. Phone/Fax

Practice location:
  • Phone: 218-624-4819
  • Fax: 218-624-7323
Mailing address:
  • Phone: 218-624-4819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRY R JACOBSON
Title or Position: CEO
Credential:
Phone: 218-740-2330