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General NPI Number Information
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NPI Number | 1871979237
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Entity Type | Organization
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Legal Business Name | STILLWATER MEDICAL GROUP
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 08/07/2015
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Provider Practice Location Address
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Address Line | 1500 CURVE CREST BLVD W
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City | STILLWATER
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State | MN
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Zip | 55082-6040
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Country | US
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Telephone | 651-439-1234
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1309 MS 21110Q
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City | MINNEAPOLIS
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State | MN
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Zip | 55440-1309
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MATT RICHIE
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Credential |
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Telephone | 651-439-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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