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General NPI Number Information
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NPI Number | 1568557544
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Entity Type | Organization
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Legal Business Name | UNITED CLINICS OF FARIBAULT COUNTY
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 435 S GROVE ST STE 1
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City | BLUE EARTH
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State | MN
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Zip | 56013-2605
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Country | US
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Telephone | 507-526-7388
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Fax |
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Provider Business Mailing Address
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Address Line | 435 S GROVE ST STE 1
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City | BLUE EARTH
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State | MN
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Zip | 56013-2605
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Country | US
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Telephone | 507-526-7388
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Fax |
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | TAMY J TVEDTEN
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Credential |
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Telephone | 507-526-7388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1475
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License Number State | MN
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