Healthcare Provider Details

I. General information

NPI: 1770774317
Provider Name (Legal Business Name): RIDGEVIEW CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 LEWIS AVE S
WATERTOWN MN
55388-4500
US

IV. Provider business mailing address

204 LEWIS AVE S
WATERTOWN MN
55388-4500
US

V. Phone/Fax

Practice location:
  • Phone: 952-955-1963
  • Fax:
Mailing address:
  • Phone: 952-955-1963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number22150
License Number StateMN

VIII. Authorized Official

Name: MS. KRISTI L BESSE
Title or Position: OPERATIONS MGR
Credential:
Phone: 952-442-7890