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Organization
APPLE VALLEY MEDICAL CLINIC, LTD.
Active
Organization
APPLE VALLEY MEDICAL CLINIC, LTD.
Active
Parent organization
APPLE VALLEY MEDICAL CLINIC, LTD.
Organization subpart
Yes
Provider details
NPI number
Legal business name
APPLE VALLEY MEDICAL CLINIC, LTD.
Authorized official
MR. MARK POTTENGER (ADMINISTRATOR)
(952) 953-9285
Entity
Organization
Contact information
Practice address
14655 GALAXIE AVE, APPLE VALLEY, MN 55124-8575
(952) 432-6161
Mailing address
14655 GALAXIE AVE, APPLE VALLEY, MN 55124-8575
(952) 432-6161
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
723
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22345AP
BLUEE CROSS BLUE SHIELD
—
01
—
55108
HEALTHPARTNERS
—
01
—
679251001
MEDICARE
—
01
—
858098
PREFERRED ONE
—
01
—
CE7163
RAILROAD MEDICARE
—
Enumeration date
07/06/2010
Last updated
06/19/2017
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