Healthcare Provider Details

I. General information

NPI: 1952363699
Provider Name (Legal Business Name): AFFILIATED COMMUNITY MEDICAL CENTERS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WILLMAR AVE SW AFFILIATED COMMUNITY MEDICAL CENTERS
WILLMAR MN
56201-3556
US

IV. Provider business mailing address

101 WILLMAR AVE SW AFFILIATED COMMUNITY MEDICAL CENTERS
WILLMAR MN
56201-3556
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-5079
  • Fax: 320-231-5067
Mailing address:
  • Phone: 320-231-5079
  • Fax: 320-231-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number1309
License Number StateMN

VIII. Authorized Official

Name: CINDY F SMITH
Title or Position: CEO
Credential: MD
Phone: 320-231-5000