NPIMap

Organization Active NPI

Midwest Regenerative Medicine Center PC

  • Multi-Specialty Clinic/Center
  • Warren, MN
National Provider Identifier
1245791763
Registry record updated Mar 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MIDWEST REGENERATIVE MEDICINE CENTER PC
Practice address
603 N Main St
Warren, MN 56762-1122
Phone
(218) 745-6655
NPI assigned
Mar 27, 2019
Last updated
Mar 27, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark PedersonNPI 1215045604
Title
Owner
Phone
(218) 745-6655

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

603 N Main St
Warren, MN 56762-1122

Mailing address

603 N Main St
Warren, MN 56762-1122
Phone (218) 745-6655

National Provider Directory

National Provider Directory

Locations

603 N Main St
Warren, MN 56762
Phone (218) 201-3003

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553644800000",
    "number": "1245791763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 N MAIN ST",
            "city": "WARREN",
            "state": "MN",
            "postal_code": "567621122",
            "telephone_number": "218-745-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 N MAIN ST",
            "city": "WARREN",
            "state": "MN",
            "postal_code": "567621122",
            "telephone_number": "218-745-6655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST REGENERATIVE MEDICINE CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-27",
        "last_updated": "2019-03-27",
        "status": "A",
        "authorized_official_last_name": "PEDERSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-745-6655",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.