DIVINE PROVIDENCE MEDICAL CLINIC; NPI #1972660488

Contact Information

DIVINE PROVIDENCE MEDICAL CLINIC

312 E GEORGE ST
IVANHOE, MN 56142-9707

Phone: 507-694-1414
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Critical Access Hospital	261QC0050X

Indicates primary specialty

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NPI Profile & details for DIVINE PROVIDENCE MEDICAL CLINIC

NPI # 1972660488

LBN Legal business name DIVINE PROVIDENCE MEDICAL CLINIC

Authorized official GREGORY WILSON - (CEO)

Entity Organization

Organization subpart ¹ No

Enumeration date 01/03/2007

Last updated 08/22/2020 - About 6 years ago

Identifiers

License #

331042

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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