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Contact Information

GREAT RIVER ENDODONTICS, PA
1100 19TH AVE SW
WILLMAR, MN56201-5006
 Phone: 320-259-5078
 Fax: 320-259-5078
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Endodontics

1223E0200X
Indicates primary specialty

NPI Profile & details for GREAT RIVER ENDODONTICS, PA

NPI # 1144583527
LBN Legal business name GREAT RIVER ENDODONTICS, PA
Authorized official THOMAS KARN - (OWNER/PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 06/20/2012
Last updated 06/20/2012 - About 14 years ago
Identifiers
MN License # 11880
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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