Healthcare Provider Details

I. General information

NPI: 1467504977
Provider Name (Legal Business Name): RIDGEVIEW CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 4TH ST N
WINSTED MN
55395
US

IV. Provider business mailing address

PO BOX 718
WINSTED MN
55395-0718
US

V. Phone/Fax

Practice location:
  • Phone: 320-485-4803
  • Fax: 320-485-4499
Mailing address:
  • Phone: 320-485-4803
  • Fax: 320-485-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25217
License Number StateMN

VIII. Authorized Official

Name: KRISTI BESSE
Title or Position: CREDENTIALING
Credential:
Phone: 952-495-2000