Provider Demographics
NPI:1770774317
Name:RIDGEVIEW CLINICS
Entity type:Organization
Organization Name:RIDGEVIEW CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-442-7890
Mailing Address - Street 1:204 LEWIS AVE S
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55388-4500
Mailing Address - Country:US
Mailing Address - Phone:952-955-1963
Mailing Address - Fax:
Practice Address - Street 1:204 LEWIS AVE S
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MN
Practice Address - Zip Code:55388-4500
Practice Address - Country:US
Practice Address - Phone:952-955-1963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22150208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA96328Medicare UPIN