Basic Information
| Provider Information | |||||||||
| NPI: | 1649470782 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTHPARTNERS RC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | OLIVIA HOSPITAL & CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 100 HEALTHY WAY | ||||||||
| Address2: | |||||||||
| City: | OLIVIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562771117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205231261 | ||||||||
| FaxNumber: | 3205233458 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HEALTHY WAY | ||||||||
| Address2: | |||||||||
| City: | OLIVIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562771117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205231261 | ||||||||
| FaxNumber: | 3205233458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2007 | ||||||||
| LastUpdateDate: | 05/01/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BLAD | ||||||||
| AuthorizedOfficialFirstName: | NATHAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3205233575 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC0050X | Y | Ambulatory Health Care Facilities | Clinic/Center | Critical Access Hospital |
No ID Information.