Healthcare Provider Details

I. General information

NPI: 1861675159
Provider Name (Legal Business Name): ROCHESTER CLINIC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 WELLNER DR NE
ROCHESTER MN
55906-8427
US

IV. Provider business mailing address

3070 WELLNER DR NE
ROCHESTER MN
55906-8427
US

V. Phone/Fax

Practice location:
  • Phone: 507-218-3095
  • Fax: 507-218-3097
Mailing address:
  • Phone: 507-218-3095
  • Fax: 507-218-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JENGYU LAI
Title or Position: CHIEF MANAGER
Credential: DPM
Phone: 507-218-3095