Basic Information
| Provider Information | |||||||||
| NPI: | 1295276483 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIDGEVIEW MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 S MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | WACONIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553871752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524422191 | ||||||||
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| Practice Location | |||||||||
| Address1: | 551 4TH ST N | ||||||||
| Address2: | |||||||||
| City: | WINSTED | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553954523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524423190 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 03/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | WHISNEY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRIMARY CARE PROVIDER OPPORTUNITIES | ||||||||
| AuthorizedOfficialTelephone: | 9524422191 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 12374 | MN | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.