MEDICARE: RIDGEVIEW CLINICS

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	363AM0700X	Medical Physician Assistant	9792	MN
2	207X00000X	Orthopaedic Surgery Physician	19168	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407051154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDGEVIEW CLINICS

Provider Business Mailing Address
First Line	:	PO BOX 1007
Second Line	:
City	:	HOWARD LAKE
State	:	MN
Zip	:	55349-1007
Country	:	US
Telephone Number	:	320-543-2591
Fax Number	:	320-543-2693

Provider Business Practice Location Address
First Line	:	900 6TH ST
Second Line	:
City	:	HOWARD LAKE
State	:	MN
Zip	:	55349-5647
Country	:	US
Telephone Number	:	952-442-3190
Fax Number	:	952-442-3185

Authorized Official
Title or Position	:	OPERATIONS & BUSINESS OFFICE MANAGE
Name	:	KRISTI BESSE
Credential	:
Telephone Number	:	952-442-7895

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	06/10/2009

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Directions to “RIDGEVIEW CLINICS ” Practice Location

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