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Organization
NORTHSIDE MEDICAL CENTER, PLC
Active
Organization
NORTHSIDE MEDICAL CENTER, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIZ M SORENSON (CLINIC ADMINISTRATOR)
(320) 839-6157
Entity
Organization
Contact information
Practice address
465 EASTVOLD AVE, ORTONVILLE, MN 56278-1107
(320) 839-6157
(320) 839-3851
Mailing address
465 EASTVOLD AVE, ORTONVILLE, MN 56278-1107
(320) 839-6157
(320) 839-3851
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01011119
PREFERRED ONE
MN
01
—
05647NO
BCBS OF MN
MN
01
—
106639
UCARE OF MINNESOTA
MN
05
—
794447100
—
MN
01
—
CJ3171
RAILROAD MEDICARE
MN
Enumeration date
03/16/2006
Last updated
12/08/2008
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