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General NPI Number Information
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NPI Number | 1619915543
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Entity Type | Organization
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Legal Business Name | FERGUS FALLS MEDICAL GROUP, P.A.
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 403 12TH ST N
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City | WHEATON
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State | MN
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Zip | 56296-1070
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Country | US
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Telephone | 320-563-8295
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Fax | 320-563-8014
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Provider Business Mailing Address
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Address Line | 615 S MILL ST
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City | FERGUS FALLS
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State | MN
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Zip | 56537-2756
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Country | US
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Telephone | 218-739-2221
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Fax | 218-739-5501
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Authorized Official
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Title or Position | CEO
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Name | JIM WILKUS
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Credential |
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Telephone | 218-739-2221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 44
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License Number State | MN
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