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General NPI Number Information
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NPI Number | 1770726671
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Entity Type | Organization
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Legal Business Name | RIDGEVIEW CLINICS
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 490 S MAPLE ST SUITE 204
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City | WACONIA
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State | MN
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Zip | 55387-1760
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Country | US
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Telephone | 952-442-2191
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Fax |
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Provider Business Mailing Address
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Address Line | 490 S MAPLE ST SUITE 204
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City | WACONIA
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State | MN
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Zip | 55387-1760
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Country | US
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Telephone | 952-442-2191
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Fax |
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MS. KRISTI A BESSE
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Credential |
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Telephone | 952-442-7895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 22924
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License Number State | MN
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