| True Grace Clinic Ltd | |
|
1300 Northridge Ct Nw Ste 2 Pine City MN 55063-5846 | |
| (320) 372-2312 | |
| Not Available |
| Full Name | True Grace Clinic Ltd |
|---|---|
| Speciality | Clinic/Center |
| Location | 1300 Northridge Ct Nw Ste 2, Pine City, Minnesota |
| Authorized Official Name and Position | Tina Keller (VP COMPLIANCE) |
| Authorized Official Contact | 3203722323 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| True Grace Clinic Ltd 501 Main St Sandstone MN 55072-4410 | True Grace Clinic Ltd 1300 Northridge Ct Nw Ste 2 Pine City MN 55063-5846 Ph: (320) 372-2312 |
| NPI Number | 1780480582 |
|---|---|
| Provider Enumeration Date | 02/21/2025 |
| Last Update Date | 01/04/2026 |
| Certification Date | 01/04/2026 |
| Medicare PECOS PAC ID | 7517466907 |
|---|---|
| Medicare Enrollment ID | O20250814000774 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780480582 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Primary |
| 324500000X | Substance Abuse Rehabilitation Facility | (NU) | Secondary |
| 207Q00000X | Family Medicine | (NU) | Secondary |
| Provider Name | Vikas Simon Mittal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629038377 PECOS PAC ID: 2961425079 Enrollment ID: I20060104000359 |
| Provider Name | Danielle M Carlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962946509 PECOS PAC ID: 7911281308 Enrollment ID: I20170302001909 |
| Provider Name | Naomi Jean Koenig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659893170 PECOS PAC ID: 5193099240 Enrollment ID: I20170928000215 |
| Provider Name | Shelly Anne Kuhlmann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215797113 PECOS PAC ID: 1951749035 Enrollment ID: I20240409002138 |
| Provider Name | Karron L Cohoon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902379613 PECOS PAC ID: 9638417843 Enrollment ID: I20241014004404 |
| Provider Name | Joleen a Peters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023845377 PECOS PAC ID: 6709313414 Enrollment ID: I20241219001013 |
| Provider Name | Joshua Larsen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366214488 PECOS PAC ID: 4789183260 Enrollment ID: I20250820002093 |
Hultman Lake Enterprises Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 805 Main St S, Pine City, MN 55063 Phone: 320-629-5288 |
Pine City Family Dental Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1105 Hillside Ave Sw, Pine City, MN 55063 Phone: 320-629-2789 |
Pine City Area Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 510 2nd St Se, Pine City, MN 55063 Phone: 320-629-6721 Fax: 320-629-1097 |
Fairview Clinics-pine City Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 Evergreen Sq Sw, Pine City, MN 55063 Phone: 320-629-6721 |
Welia Health Pine City Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1425 Main Street North, Pine City, MN 55063 Phone: 320-629-7505 Fax: 320-629-2202 |