FAMILY PRACTICE MEDICAL CENTER, PA (NPI# 1366487795) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366487795 |
| Entity Type | Organization |
| Organization Name | FAMILY PRACTICE MEDICAL CENTER, PA |
| Practice Address |
502 2nd St Sw Suite 1 Willmar MN 56201-3365 |
| Practice Telephone | 3202357232 |
| Mailing Telephone | 3202357232 |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2019-05-16 |
| Authorized Official Name | ANTHONY AMON (CEO) |
| Authorized Official Telephone | 3202357232 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | U CARE | 106640 | 01 |
| MN | 427510100 | 05 | |
| MN | BLUE CROSS BLUE SHIELD | 45215FA | 01 |
| Street Address |
502 2ND ST SW SUITE 1 |
| City | WILLMAR |
| State | MN |
| Zip Code | 56201-3365 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053390377 | Maria Jones Loerzel | Family Medicine | 502 2nd St Sw, Suite 1, Willmar, MN 56201-3365 | 2006-01-13 |
| 1659710820 | Jessica Jo Martinez | Nurse Practitioner | 502 2nd St Sw, Suite 1, Willmar, MN 56201-3365 | 2013-06-20 |
| 1790927077 | Willmar Foot & Ankle Clinic | Podiatrist | 502 2nd St Sw, Willmar, MN 56201-3337 | 2009-04-01 |
| 1326238973 | Janice Kae Forkrud | Dietitian, Registered | 502 2nd St Sw, Suite 1, Willmar, MN 56201-3337 | 2007-07-30 |
| 1003956947 | Cheryl Block Hansen | Social Worker | 502 2nd St Sw, Willmar, MN 56201-3337 | 2007-02-08 |
| 1467558197 | Aimee Lyn Tebrake | Clinical Nurse Specialist | 502 2nd St Sw, Willmar, MN 56201-3365 | 2006-09-16 |
| 1982618674 | Kristel L Arcilla | Family Medicine | 502 2nd St Sw, Suite 1, Willmar, MN 56201-3365 | 2006-07-28 |
| 1144243833 | Rachel L Tollefsrud | Family Medicine | 502 2nd St Sw, Suite 1, Willmar, MN 56201-3365 | 2006-07-25 |
| 1457374035 | Andrew A Hoffmann | Family Medicine | 502 2nd St Sw, Suite 1, Willmar, MN 56201-3365 | 2006-07-25 |
| 1972526564 | Anthony G Amon | Family Medicine | 502 2nd St Sw, Suite 1, Willmar, MN 56201-3365 | 2006-07-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730793472 | Sarah Erickson | Counselor | 2120 60th Ave N.w., Willmar, MN 56201 | 2020-09-01 |
| 1417560681 | Amy Engle | Nurse Practitioner | 1125 Se 8th Street, Willmar, MN 56201 | 2020-08-28 |
| 1154856524 | Mude Transportation Inc | Non-emergency Medical Transport (VAN) | 1712 Monongalia Ave Sw Ap1, Willmar, MN 56201 | 2017-04-24 |
| 1285025874 | Jill Fellows | Occupational Therapist | 611 5th St. Sw, Willmar, MN 56201 | 2015-02-18 |
| 1700294881 | Brenda Wiese | Counselor | 1617 Hwy 12 E, Suite 230, Willmar, MN 56201 | 2014-08-01 |
| 1275955932 | Courtney Regnier | Marriage & Family Therapist | 2320 E Hwy 12 Ste 2, Willmar, MN 56201 | 2014-01-15 |
| 1568732402 | Pamela Jean Kubesh | Social Worker | 328 Sw 3rd Street, Willmar, MN 56201 | 2012-01-10 |
| 1699931824 | Community Behavioral Health Hospital-willmar | Psychiatric Hospital | 1208 Olena Ave Se, Willmar, MN 56201 | 2008-08-07 |
| 1700053345 | Nathan Schrick | Marriage & Family Therapist | 513 Sw 5th Street, Box 1810, Willmar, MN 56201 | 2008-05-13 |
| 1831381680 | Joan M Blonigan Christianson | Chiropractor | 1101 S 1st Street, Willmar, MN 56201 | 2007-08-15 |
| Find all providers in zip 56201 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851820799 | Miller Chiropractic Office | Clinic/Center | 1804 Trott Ave Sw, Willmar, MN 56201-2743 | 2017-06-05 |
| 1760674782 | Backhaus Eye Service, Inc | Clinic/Center | 2404 1st St S, Willmar, MN 56201-6300 | 2007-08-14 |
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| 1811513310 | Prescribed By LLC | Clinic/Center | 701 Washington Ave N Ste 111-321, Minneapolis, MN 55401-2822 | 2020-06-19 |
| 1992320014 | Jtp Professional Service Corporation | Clinic/Center | 2038 Ford Pkwy # 444, Saint Paul, MN 55116-1931 | 2020-06-15 |
| 1689299125 | Altru Health System | Clinic/Center | 1st & Roosevelt, Karlstad, MN 56732 | 2020-06-10 |
| 1831710409 | Webmed LLC | Clinic/Center | 925 E Superior St Ste 113, Duluth, MN 55802-2253 | 2020-05-05 |
| 1073149779 | Functional Chiropractic Rehab, Pllc | Clinic/Center | 1901 Madison Ave Ste 120, Mankato, MN 56001-6267 | 2020-03-14 |
| 1225676067 | Liana Healthcare P.ll.c | Clinic/Center | 8348 Beard Rd, Bloomington, MN 55431-1028 | 2019-12-11 |
| 1245875293 | Fairview Clinics | Clinic/Center | 12912 Farnham Ave N, White Bear Lake, MN 55110-5929 | 2019-11-14 |
| 1275175242 | Hye-kyong Kim Therapy LLC | Clinic/Center | 1145 Grand Ave # 101, Saint Paul, MN 55105-2629 | 2019-10-11 |
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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.