NORTHSIDE MEDICAL CENTER, PLC (NPI# 1265401681) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265401681 |
| Entity Type | Organization |
| Organization Name | NORTHSIDE MEDICAL CENTER, PLC |
| Practice Address |
465 Eastvold Ave Ortonville MN 56278-1107 |
| Practice Telephone | 3208396157 |
| Practice Fax Number | 3208393851 |
| Mailing Telephone | 3208396157 |
| Mailing Fax Number | 3208393851 |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2008-12-08 |
| Authorized Official Name | LIZ M SORENSON (CLINIC ADMINISTRATOR) |
| Authorized Official Telephone | 3208396157 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208D00000X | General Practice | Allopathic & Osteopathic Physicians | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | PREFERRED ONE | 01011119 | 01 |
| MN | BCBS OF MN | 05647NO | 01 |
| MN | RAILROAD MEDICARE | CJ3171 | 01 |
| MN | 794447100 | 05 | |
| MN | UCARE OF MINNESOTA | 106639 | 01 |
| Street Address |
465 EASTVOLD AVE |
| City | ORTONVILLE |
| State | MN |
| Zip Code | 56278-1107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801305495 | Thomas Letrud II | Physical Therapy Assistant | 10 4th St Se, Ortonville, MN 56278 | 2017-09-26 |
| 1649528225 | Amanda Heinrich | Physical Therapist | 320 Washington Avenue, Ortonville, MN 56278 | 2012-08-29 |
| 1740304963 | Fairway View Senior Community | Assisted Living Facility | 215 Lundell Avenue, Ortonville, MN 56278 | 2007-03-16 |
| 1124044656 | Big Stone Therapies,inc | Occupational Therapy Assistant | 309 Washington Ave, Big Stone Therapies Inc, Ortonville, MN 56278 | 2006-07-15 |
| 1225019771 | Christopher J Conroy | Optometrist | 217 3rd Street Nw, Ortonville, MN 56278 | 2005-11-10 |
| 1962403295 | Ortonville Area Health Services | Skilled Nursing Facility | 201 Mark Drive, Ortonville, MN 56278 | 2005-08-09 |
| 1841544772 | Connect Hearing, Inc. | Audiologist | 435 Eastvold Ave, Ortonville, MN 56278-1107 | 2012-10-30 |
| 1992290100 | Brittany Lynn Swigerd | Registered Nurse | 450 Eastvold Ave, Ortonville, MN 56278-1133 | 2018-06-29 |
| 1679533111 | Bradley Runia | Physical Therapist | 820 Roy St, Ortonville, MN 56278-1138 | 2006-03-27 |
| 1063644524 | Laura Mikkelsen | Physical Therapist | 820 Roy St, Ortonville, MN 56278-1138 | 2009-08-18 |
| Find all providers in zip 56278 | ||||
| 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 |
|---|---|---|---|---|
| 1558733204 | M15 Family Care PC | Family Medicine | 250 N Ortonville Rd, Suite C, Ortonville, MI 48462-8308 | 2015-10-21 |
| 1518359447 | M 15 Urgent Care PC | Family Medicine | 250 N. Ortonville Rd., Ste #c, Ortonville, MI 48462 | 2015-03-02 |
| 1518395193 | Dr. Bob Country Doctor Pllc | Family Medicine | 1306 Kent Rd, Ortonville, MI 48462-8528 | 2013-10-17 |
| 1194169946 | Sarah Jean Ristvedt | Family Medicine | 450 Eastvold Ave, Ortonville, MN 56278-1252 | 2013-04-24 |
| 1295026532 | Grant Wade Botker | Family Medicine | 450 Eastvold Ave, Ortonville, MN 56278-1252 | 2011-04-20 |
| 1831415694 | Susan M Andersen | Family Medicine | 450 Eastvold Ave, Ortonville, MN 56278-1252 | 2010-04-19 |
| 1124244926 | Stephanie D Estrellas | Family Medicine | 1221 S Ortonville Rd, Ortonville, MI 48462-8676 | 2007-04-18 |
| 1912042557 | Julie Race Knas | Family Medicine | 180 N Ortonville Rd, Ortonville, MI 48462-8575 | 2007-02-21 |
| 1831291640 | Antonio R Deleon | Family Medicine | 1221 S Ortonville Rd, Ortonville, MI 48462-8676 | 2006-09-02 |
| 1275557464 | Linda L Loewenstein | Family Medicine | 180 N Ortonville Rd, Ortonville, MI 48462-8575 | 2006-07-27 |
| Find all providers in ORTONVILLE | ||||
| City | ORTONVILLE |
| Zip Code | 56278 |
Please comment or provide details below to improve the information on NORTHSIDE MEDICAL CENTER, PLC.
| 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.