Healthcare Provider Details

I. General information

NPI: 1962899302
Provider Name (Legal Business Name): AFFILIATED COMMUNITY MEDICAL CENTERS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WILLMAR AVE SW
WILMLAR MN
56201-3591
US

IV. Provider business mailing address

101 WILLMAR AVE SW
WILMLAR MN
56201-3591
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 TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP3732
License Number StateMN

VIII. Authorized Official

Name: RONALD L HOLMGREN
Title or Position: PRESIDENT
Credential: MD
Phone: 320-231-5079