Pine City Area Clinic

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PINE CITY AREA CLINIC

Practice address

510 2ND St SE
Pine City, MN 55063-1706

Phone

(320) 629-6721

Fax

(320) 629-1097

NPI assigned

Oct 4, 2006

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Rick A McMahon, CPA

Title

Ceo

Phone

(320) 629-6721

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1437244431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 2ND ST SE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550631706",
            "telephone_number": "320-629-6721",
            "fax_number": "320-629-1097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 2ND ST SE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550631706",
            "telephone_number": "320-629-6721",
            "fax_number": "320-629-1097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE CITY AREA CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "MCMAHON",
        "authorized_official_first_name": "RICK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "320-629-6721",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "52757PI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Marie Olson, CNP
• Karen Lynn Overholser Hovland, RN, PHN
• Samantha Partch, MA, LPCC
• Marilyn Jean Pedersen, LADC
• Hiedi Philstrom
• Pine City Chiropractic PLLC (Northern Roots Chiropractic)
• Pine City Family Dental
• Pine Eye Associates, PA (Pine Eye Associates)
• Michaela Janssen Pohl, MA, LPCC
• Jeffrey Pounds, LP

• Clinic/Center in Pine City, MN
• Providers in Pine City, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.