| Apple Valley Medical Clinic, Ltd. | |
|
14655 Galaxie Ave Apple Valley MN 55124 | |
| (952) 432-6161 | |
| (952) 432-7019 |
| Full Name | Apple Valley Medical Clinic, Ltd. |
|---|---|
| Speciality | Family Medicine |
| Location | 14655 Galaxie Ave, Apple Valley, Minnesota |
| Authorized Official Name and Position | Cathy Wasson (SYSTEMS MANAGER/SECURITY OFFICER) |
| Authorized Official Contact | 9529979313 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Apple Valley Medical Clinic, Ltd. 14655 Galaxie Ave Apple Valley MN 55124-8575 Ph: (952) 432-6161 | Apple Valley Medical Clinic, Ltd. 14655 Galaxie Ave Apple Valley MN 55124 Ph: (952) 432-6161 |
| NPI Number | 1477599918 |
|---|---|
| Provider Enumeration Date | 06/22/2006 |
| Last Update Date | 06/11/2018 |
| Medicare PECOS PAC ID | 0941199905 |
|---|---|
| Medicare Enrollment ID | O20130814000300 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477599918 | NPI | - | NPPES |
| 989883200 | Medicaid | MN | |
| CE7163 | Other | MN | MEDICARE RAILROAD |
| 22345AP | Other | MN | BLUE CROSS BLUE SHIELD |
| 6792510001 | Other | MN | MEDICARE |
| 858098 | Other | MN | PREFERRED ONE |
| 594010900 | Medicaid | MN | |
| C00152 | Other | PTAN | |
| 55108 | Other | MN | HEALTHPARTNERS UC |
| 587 | Other | MN | HEALTHPARTNERS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 723 (Minnesota) | Primary |
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