Organization Name: | BUFFALO CLINIC, P.A. |
NPI Number: | 1205022845 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JASON S HALVORSON (PRESIDENT) |
Mailing Address: | 11091 Jason Ave Ne Albertville |
State: | MN US |
Postal Code: | 55301 |
Phone Number: | 7636848300 |
Fax Number: | |
NPI Enumeration Date: | 09/18/2007 |
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: |