MEDICARE: ON CALL CLINICIANS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center	7810	MN
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center	LP0508	MN

General Provider Information

NPI Number	:	1356671754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON CALL CLINICIANS, INC.

Provider Business Mailing Address
First Line	:	5861 CEDAR LAKE RD S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-1481
Country	:	US
Telephone Number	:	763-544-1000
Fax Number	:	763-541-1076

Provider Business Practice Location Address
First Line	:	5861 CEDAR LAKE RD S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-1481
Country	:	US
Telephone Number	:	763-544-1000
Fax Number	:	763-541-1076

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JUDY GOLDETSKY
Credential	:	M. A.
Telephone Number	:	763-545-6017

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	07/25/2013

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