Basic Information
| Provider Information | |||||||||
| NPI: | 1801176268 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PERHAM HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PERHAM HEALTH NEW YORK MILLS CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 W CENTENNIAL 84 DRIVE | ||||||||
| Address2: | PO BOX D | ||||||||
| City: | NEW YORK MILLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565670364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183851800 | ||||||||
| FaxNumber: | 2183851830 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 W CENTENNIAL 84 DRIVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK MILLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565670364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183851800 | ||||||||
| FaxNumber: | 2183851830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2011 | ||||||||
| LastUpdateDate: | 08/17/2011 | ||||||||
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| AuthorizedOfficialLastName: | LECLERC | ||||||||
| AuthorizedOfficialFirstName: | MARTHA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7012346248 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.