Healthcare Provider Details

I. General information

NPI: 1316253255
Provider Name (Legal Business Name): OLMSTED MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 ELTON HILLS DR NW STE 200
ROCHESTER MN
55901-3564
US

IV. Provider business mailing address

102 ELTON HILLS DR NW STE 200
ROCHESTER MN
55901-3564
US

V. Phone/Fax

Practice location:
  • Phone: 507-280-1824
  • Fax:
Mailing address:
  • Phone: 507-280-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEVIN HIGGINS
Title or Position: CFO
Credential:
Phone: 507-529-6610