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General NPI Number Information
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NPI Number | 1720086028
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Entity Type | Organization
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Legal Business Name | CCM HEALTH
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 824 N 11TH ST
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City | MONTEVIDEO
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State | MN
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Zip | 56265
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Country | US
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Telephone | 320-269-8877
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Fax | 320-269-8186
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Provider Business Mailing Address
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Address Line | 824 N 11TH ST
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City | MONTEVIDEO
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State | MN
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Zip | 56265-1629
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Country | US
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Telephone | 320-269-8877
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Fax | 320-269-8186
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Authorized Official
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Title or Position | CFO
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Name | DESERAE ANSPACH
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Credential |
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Telephone | 320-269-8877
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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 |
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 327693
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License Number State | MN
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