NICHOLAS BRIAN VIDOR (NPI# 1063704914) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063704914 |
| Entity Type | Individual |
| Full Name | NICHOLAS BRIAN VIDOR |
| Credential | M.D. |
| Practice Address |
20 5th St Se Cook MN 55723-9702 |
| Practice Telephone | 2186665102 |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2014-07-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 55493 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 1063704914 | 05 | |
| MEDICA | 0001-0100257 | 01 | |
| MN | RR MEDICARE | P01099801 | 01 |
| MN | BCBS | 1063704914 | 01 |
| Street Address |
20 5TH ST SE |
| City | COOK |
| State | MN |
| Zip Code | 55723-9702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538132774 | Cook Area Health Services, Inc | Clinic/Center | 20 5th St Se, Cook, MN 55723-9702 | 2006-02-08 |
| 1962069914 | Peggy Jean Stepan | Dentist | 20 5th St Se, Cook, MN 55723-9702 | 2019-05-24 |
| 1588142913 | Stephanie Rae Lantry | Nurse Practitioner | 20 5th St Se, Cook, MN 55723-9702 | 2018-07-28 |
| 1336662105 | Brittany Ann Debeltz | Registered Nurse | 20 5th St Se, Cook, MN 55723-9702 | 2017-07-24 |
| 1740717271 | Michael Morris Talberg | Dentist | 20 5th St Se, Cook, MN 55723-9702 | 2017-05-15 |
| 1952769697 | Robert Alan Wightman | Dentist | 20 5th St Se, Cook, MN 55723-9702 | 2016-02-09 |
| 1912371311 | Ehab Aly Nour Rezk | Dentist | 20 5th St Se, Cook, MN 55723-9702 | 2015-11-23 |
| 1841629250 | Charlene M Colwell | Social Worker | 20 5th St Se, Cook, MN 55723-9702 | 2013-11-06 |
| 1306284153 | Rachel S Beldo | Nurse Practitioner | 20 5th St Se, Cook, MN 55723-9702 | 2013-06-13 |
| 1477826436 | Celin R Williams | Social Worker | 20 5th St Se, Cook, MN 55723-9702 | 2012-02-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225258320 | Turning Point Counseling Pa | Marriage & Family Therapist | 19 E Vermilion Dribe, Suite B, Cook, MN 55723 | 2007-04-30 |
| 1639295124 | Linda Ann Albertson | Marriage & Family Therapist | 19 E Vermillon Dr, Suite B Turning Point Counseling Pa, Cook, MN 55723 | 2007-03-22 |
| 1093850950 | City of Cook | Ambulance | 127 S River St, Cook, MN 55723 | 2007-02-20 |
| 1346337128 | Franks Pharmacy Inc | Pharmacy | #1 West Vermilion Drive, Cook, MN 55723 | 2006-10-05 |
| 1164514493 | Cook Chiropractic Center Ltd. | Chiropractor | 19 E Vermilion Dr, Po 395, Cook, MN 55723 | 2006-09-28 |
| 1497930861 | Bradley Scott Horoshak | Chiropractor | 19 E Vermilion Dr, Po 395, Cook, MN 55723 | 2008-01-04 |
| 1508086679 | Speare Psychological Services Pa | Psychologist | 225 1st St N, Suite 3100, Virginia, MN 55723 | 2007-04-30 |
| 1750421160 | Jerel Dean Johnson | Technician/Technologist | 23 East Vermilion Ave, Cook, MN 55723-0127 | 2007-02-07 |
| 1275731317 | Minnesota Correctional Facility -togo | Substance Abuse Rehabilitation Facility | 62741 County Road 551, Togo, MN 55723-4509 | 2007-07-10 |
| 1659508182 | True Care Medical Therapy Center Inc | Occupational Therapist | 221 Highway 53, Suite D, Cook, MN 55723-5102 | 2009-06-10 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902989940 | Mary Frances Hughes | Family Medicine | 20 5th St Se, Cook, MN 55723-9702 | 2006-10-23 |
| 1447349022 | Bruce David Garbisch | Family Medicine | 20 5th St Se, Cook, MN 55723-9702 | 2006-10-12 |
| 1841381852 | Lynne M Didrikson I | Family Medicine | 20 5th St Se, Cook, MN 55723-9702 | 2006-09-27 |
| 1770508103 | Fred Lawrence Webber | Family Medicine | 20 5th St Se, Cook, MN 55723-9702 | 2006-07-13 |
| 1255305942 | Harold D Johnston | Family Medicine | 20 5th St Se, Medical, Cook, MN 55723-9702 | 2006-02-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295349280 | Anna Dalrymple | Family Medicine | 3832 Mcknight Rd N, White Bear Lake, MN 55110-4874 | 2020-09-07 |
| 1760005771 | Revive Pain Centers Pa | Family Medicine | 14525 Highway 7 Ste 375, Minnetonka, MN 55345-3741 | 2020-05-26 |
| 1245862697 | North Iowa Mercy Clinics | Family Medicine | 2440 Bridge Ave, Albert Lea, MN 56007-2005 | 2020-02-04 |
| 1477196715 | The Doctors Medical Clinic, P.a. | Family Medicine | 1504 Whitebear Ave, St Paul, MN 55106 | 2019-10-18 |
| 1699336511 | Ruth Archibald | Family Medicine | 6962 Cottonwood Ct Nw, Rochester, MN 55901-8835 | 2019-06-21 |
| 1295399251 | Roberta Lynn Kopel | Family Medicine | 1605 W Lincoln Ave, Olivia, MN 56277-1260 | 2019-04-25 |
| 1558834390 | Donna Mae Mullenix | Family Medicine | 2849 Cty Rd 103, Barnum, MN 55707 | 2019-01-04 |
| 1083189203 | Altru Health System | Family Medicine | 23076 347th Street Se, Erskine, MN 56535-9466 | 2018-10-04 |
| 1477039204 | Dollar Clinic Pllc | Family Medicine | 1002 1st Ave N, Moorhead, MN 56560-2003 | 2018-07-16 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.