MEDICARE: UNITED CLINICS OF FARIBAULT COUNTY

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	207Q00000X	Family Medicine Physician	1475	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	114000	OTHER	UCARE
2	54886	OTHER	HEALTH PARTNERS
3	0000105	OTHER	MEDICA
4	42Q09UN	OTHER	BCBS

General Provider Information

NPI Number	:	1568557544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED CLINICS OF FARIBAULT COUNTY

Provider Business Mailing Address
First Line	:	435 S GROVE ST STE 1
Second Line	:
City	:	BLUE EARTH
State	:	MN
Zip	:	56013-2605
Country	:	US
Telephone Number	:	507-526-7388
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 S GROVE ST STE 1
Second Line	:
City	:	BLUE EARTH
State	:	MN
Zip	:	56013-2605
Country	:	US
Telephone Number	:	507-526-7388
Fax Number	:

Authorized Official
Title or Position	:	CLINIC ADMINISTRATOR
Name	:	TAMY J TVEDTEN
Credential	:
Telephone Number	:	507-526-7388

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	08/22/2020

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Directions to “UNITED CLINICS OF FARIBAULT COUNTY ” Practice Location

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