Healthcare Provider Details

I. General information

NPI: 1265404115
Provider Name (Legal Business Name): WILLMAR MEDICAL SERVICES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2006
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 1ST ST S
WILLMAR MN
56201-4242
US

IV. Provider business mailing address

1320 1ST ST S PO BOX 773
WILLMAR MN
56201-4242
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-6506
  • Fax: 320-235-7069
Mailing address:
  • Phone: 320-235-6506
  • Fax: 320-235-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number327471
License Number StateMN

VIII. Authorized Official

Name: MR. TERRY TONE
Title or Position: ADMINISTRATOR
Credential:
Phone: 320-231-6766