Organization Name: | FERGUS FALLS MEDICAL GROUP, P.A. |
NPI Number: | 1134167166 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JIM WILKUS (CEO) |
Mailing Address: | 405 Main St Ashby |
State: | MN US |
Postal Code: | 563094659 |
Phone Number: | 2187472293 |
Fax Number: | 2187472294 |
NPI Enumeration Date: | 06/03/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | 44 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |