| Cos Pllc | |
|
384 3rd St Ne Waite Park MN 56387-1874 | |
| (320) 250-9188 | |
| (320) 396-7300 |
| Full Name | Cos Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 384 3rd St Ne, Waite Park, Minnesota |
| Authorized Official Name and Position | Paul Colligan (CO-OWNER) |
| Authorized Official Contact | 6027900617 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cos Pllc 384 3rd St Ne Waite Park MN 56387-1874 Ph: (320) 250-9188 | Cos Pllc 384 3rd St Ne Waite Park MN 56387-1874 Ph: (320) 250-9188 |
| NPI Number | 1083317812 |
|---|---|
| Provider Enumeration Date | 03/22/2023 |
| Last Update Date | 03/22/2023 |
| Certification Date | 03/22/2023 |
| Medicare PECOS PAC ID | 9234594425 |
|---|---|
| Medicare Enrollment ID | O20230421001323 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083317812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Emily Marie Luitjens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245587252 PECOS PAC ID: 2365695020 Enrollment ID: I20130104000392 |
| Provider Name | Amy J Lavalla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215312236 PECOS PAC ID: 8224344890 Enrollment ID: I20160510001346 |
| Provider Name | Daniel Montville |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952806093 PECOS PAC ID: 9830446756 Enrollment ID: I20190807000464 |
| Provider Name | Glen H Rebman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487181558 PECOS PAC ID: 4385998715 Enrollment ID: I20191107002271 |
| Provider Name | Juli Black |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922754134 PECOS PAC ID: 1759740368 Enrollment ID: I20230629002590 |
| Provider Name | Nicolette A Gindele |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205499464 PECOS PAC ID: 3274988043 Enrollment ID: I20231013002110 |
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