Divine Providence Medical Clinic

Primary specialty

Critical Access Hospital Clinic/CenterTaxonomy code 261QC0050X

License

331042 Issued in MN

Legal business name

DIVINE PROVIDENCE MEDICAL CLINIC

Practice address

312 E George St
Ivanhoe, MN 56142-9707

Phone

(507) 694-1414

NPI assigned

Jan 3, 2007

Organization subpart

No

Name

Mr. Gregory Wilson

Title

Ceo

Phone

(507) 694-1414

Tax ID family

Divine Providence Health Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Divine Providence Health Center

  • Medicare Defined Swing Bed Hospital Unit
  • Ivanhoe, MN
  • NPI 1265467526
  NPD tax ID
• Divine Providence Heatlh Center

  • Critical Access Hospital
  • Ivanhoe, MN
  • NPI 1629014733
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972660488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 E GEORGE ST",
            "city": "IVANHOE",
            "state": "MN",
            "postal_code": "561429707",
            "telephone_number": "507-694-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 E GEORGE ST",
            "city": "IVANHOE",
            "state": "MN",
            "postal_code": "561429707",
            "telephone_number": "507-694-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE PROVIDENCE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "507-694-1414",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "MN",
            "license": "331042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Darlene Conner
• Divine Providence Health Center
• Divine Providence Health Center Inc
• Divine Providence Heatlh Center
• Divine Providence Heatlh Center Inc.
• Emily Anne Giese, COTA
• Heidi Ann Hansen, APRN, CNP
• Linda Ann Helmberger, D,C.
• Hendricks Community Hospital Assn & Retirement Home
• Andrea Hofmeyer-Lustfield

• All providers in Ivanhoe, MN
• Critical Access Hospital Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.