Healthcare Provider Details

I. General information

NPI: 1366629461
Provider Name (Legal Business Name): RIDGEVIEW CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N CARVER ST
WINTHROP MN
55396
US

IV. Provider business mailing address

PO BOX 427
WINTHROP MN
55396-0427
US

V. Phone/Fax

Practice location:
  • Phone: 507-647-5318
  • Fax:
Mailing address:
  • Phone: 507-647-5318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number20221
License Number StateMN

VIII. Authorized Official

Name: KRISTI BESSE
Title or Position: OPERATIONS & BUSINESS OFFICE MGR
Credential:
Phone: 952-442-7895