Basic Information
| Provider Information | |||||||||
| NPI: | 1871546663 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRICOUNTY HOSPITAL INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OTTERTAIL AREA MEDICAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 232 HWY 78 N | ||||||||
| Address2: | PO BOX 129 | ||||||||
| City: | OTTERTAIL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565710129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183676262 | ||||||||
| FaxNumber: | 2183676266 | ||||||||
| Practice Location | |||||||||
| Address1: | 232 HWY 78 N | ||||||||
| Address2: | |||||||||
| City: | OTTERTAIL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565710129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183676262 | ||||||||
| FaxNumber: | 2183676266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | BEISWENGER | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2183617483 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.