Countryside Medical Clinic P.L.L.C

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

COUNTRYSIDE MEDICAL CLINIC P.L.L.C

Practice address

920 10TH St
Clarkfield, MN 56223-1377

Phone

(320) 321-2239

NPI assigned

Jun 3, 2025

Organization subpart

No

Name

Wyatt C. Haugen, CWCA-BC, CSWS-BCNPI 1487384806

Title

Clinic Owner

Phone

(320) 226-5416

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wyatt Haugen

  • Speech/Language/Hearing Specialist/Technologist
  • Clarkfield, MN
  • NPI 1487384806
  NPD Authorized official

Locations

• CountrySide IV Lounge and Wellness Doing business as
• CountrySide Medical Clinic P.L.L.C Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 15, 2026.

{
    "created_epoch": "1748908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784073600000",
    "number": "1730072075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 189",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562650189",
            "telephone_number": "320-269-1959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 10TH ST",
            "city": "CLARKFIELD",
            "state": "MN",
            "postal_code": "562231377",
            "telephone_number": "320-321-2239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE MEDICAL CLINIC P.L.L.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-03",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A",
        "authorized_official_last_name": "HAUGEN",
        "authorized_official_first_name": "WYATT",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CLINIC OWNER",
        "authorized_official_telephone_number": "320-226-5416",
        "authorized_official_credential": "CWCA-BC, CSWS-BC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CountrySide IV Lounge and Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CountrySide IV Lounge and Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CountrySide Medical Clinic P.L.L.C",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jacob Peder Bollman, O.D.
• Clarkfield Area Charter School
• Clarkfield Care Center
• Clarkfield Care Center
• Clarkfield Care Center
• Bradley Kenneth Handeland, D.C., CKTP
• Wyatt Haugen
• Larson Drug
• Open Door Health Center
• S. a. Patel D.D.S., P.a.

• All providers in Clarkfield, MN
• Medical Specialty Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2026; 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.