| Organization Name: | BUFFALO CLINIC, PA |
| NPI Number: | 1013103050 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JASON S HALVORSON (PRESIDENT) |
| Mailing Address: | 1001 Hart Blvd Ste 100 Monticello |
| State: | MN US |
| Postal Code: | 553628929 |
| Phone Number: | 7632952921 |
| Fax Number: | 7632713810 |
| NPI Enumeration Date: | 09/24/2007 |
| NPI Last Update Date: | 07/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |