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	207X00000X	Orthopaedic Surgery Physician	19168	MN
2	363AM0700X	Medical Physician Assistant	9792	MN
3	207Q00000X	Family Medicine Physician	25217	MN

General Provider Information

NPI Number	:	1831241348
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	:	320-543-2591
Fax Number	:	320-543-2693

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MS. KRISTI BESSE
Credential	:
Telephone Number	:	952-442-7890

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	11/05/2007

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Directions to “RIDGEVIEW CLINICS ” Practice Location

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