Apple Valley Medical Clinic, LTD.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

723 Issued in MN

Legal business name

APPLE VALLEY MEDICAL CLINIC, LTD.

Practice address

15100 Galaxie Ave
Apple Valley, MN 55124

Phone

(952) 432-6161

Fax

(952) 891-3921

NPI assigned

Oct 21, 2010

Last updated

Jun 19, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

APPLE VALLEY MEDICAL CLINIC, LTD.As reported in NPPES

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

Authorized official

Name

Mark Pottenger

Title

Administrator

Phone

(952) 953-9285

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Apple Valley Medical Center Sleep Lab Other name

Part of

Apple Valley Med Center

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Apple Valley Medical Clinic, LTD.

  • Family Medicine Physician
  • Apple Valley, MN
  • NPI 1477599918

  Member Of

  NPD member

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Apple Valley Medical Clinic, LTD.

  • Family Medicine Physician
  • Apple Valley, MN
  • NPI 1477599918
  NPPES parent name

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

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497830400000",
    "number": "1346550555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14655 GALAXIE AVE",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "55124",
            "telephone_number": "952-432-6161",
            "fax_number": "952-891-3921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15100 GALAXIE AVE",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "55124",
            "telephone_number": "952-432-6161",
            "fax_number": "952-891-3921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APPLE VALLEY MEDICAL CLINIC, LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "APPLE VALLEY MEDICAL CLINIC, LTD.",
        "enumeration_date": "2010-10-21",
        "last_updated": "2017-06-19",
        "status": "A",
        "authorized_official_last_name": "POTTENGER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "952-953-9285"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5CB22AP",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "22345AP",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Apple Valley Medical Center Sleep Lab",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Apple Valley Chiropractic & Rehab
• Apple Valley Chiropractic & Rehab
• Apple Valley Dental Care
• Apple Valley Eye Care P.a. (Apple Valley Eye Care)
• Apple Valley Family Dentistry
• Apple Valley Medical Clinic, LTD.
• Apple Valley Medical Clinic, LTD.
• Apple Valley Modern Dentistry, PC (Apple Valley Modern Dentistry)
• Apple Valley Operations, LLC
• Apple Valley Villa Apartments

• Family Medicine Physician in Apple Valley, MN
• Providers in Apple Valley, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2017; 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.