Healthcare Provider Details

I. General information

NPI: 1215906680
Provider Name (Legal Business Name): CITY OF SLEEPY EYE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 4TH AVENUE NW
SLEEPY EYE MN
56085-0323
US

IV. Provider business mailing address

400 4TH AVE NW
SLEEPY EYE MN
56085-1109
US

V. Phone/Fax

Practice location:
  • Phone: 507-794-3691
  • Fax: 507-794-5950
Mailing address:
  • Phone: 507-795-3691
  • Fax: 507-794-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMN

VIII. Authorized Official

Name: KEVIN ROBERT SELLHEIM
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 507-794-8440