Healthcare Provider Details

I. General information

NPI: 1083317812
Provider Name (Legal Business Name): COS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 3RD ST NE
WAITE PARK MN
56387-1874
US

IV. Provider business mailing address

384 3RD ST NE
WAITE PARK MN
56387-1874
US

V. Phone/Fax

Practice location:
  • Phone: 320-250-9188
  • Fax: 320-396-7300
Mailing address:
  • Phone: 320-250-9188
  • Fax: 320-396-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL COLLIGAN
Title or Position: CO-OWNER
Credential:
Phone: 602-790-0617