NPIMap

Organization Active NPI

Chisholm Medical Clinic

  • Family Medicine Physician
  • Chisholm, MN
National Provider Identifier
1871507632
Registry record updated Apr 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CHISHOLM MEDICAL CLINIC
Practice address
400 1St Ave SW
Suite 1
Chisholm, MN 55719-2081
Phone
(218) 254-7476
NPI assigned
Jul 28, 2006
Last updated
Apr 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2008

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

Authorized official

Name
Dr. William Wilson, MDNPI 1639284300
Title
Owner
Phone
(218) 254-7476

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
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

400 1St Ave SW
Suite 1
Chisholm, MN 55719-2081

Mailing address

3920 13TH Ave E
Suite 6
Hibbing, MN 55746-3675
Phone (218) 263-7540

Other identifiers 1

IdentifierTypeStateIssuer
55A03CHOtherMNBCBS

National Provider Directory

National Provider Directory

Locations

400 1st Ave SW
Ste 1
Chisholm, MN 55719
Phone (218) 254-5270

Practitioners & affiliated clinicians

Practitioners 6

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": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208476800000",
    "number": "1871507632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 13TH AVE E",
            "address_2": "SUITE 6",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557463675",
            "telephone_number": "218-263-7540",
            "fax_number": "866-732-0699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 1ST AVE SW",
            "address_2": "SUITE 1",
            "city": "CHISHOLM",
            "state": "MN",
            "postal_code": "557192081",
            "telephone_number": "218-254-7476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHISHOLM MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2008-04-18",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-254-7476",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "55A03CH",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chisholm, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.