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Organization
SOUTHSIDE COMMUNITY HEALTH SERVICES, INC.
Active
Organization
SOUTHSIDE COMMUNITY HEALTH SERVICES, INC.
Active
Other names
St. Croix Family Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM HENRY TENDLE JR. (EXECUTIVE DIRECTOR)
(612) 821-2800
Entity
Organization
Contact information
Practice address
5640 MEMORIAL AVE N, SUITE B, STILLWATER, MN 55082-2166
(651) 430-1880
(651) 430-1323
Mailing address
4243 4TH AVE S, MINNEAPOLIS, MN 55409-2113
(612) 822-9030
(612) 821-2818
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
943170500
—
MN
Enumeration date
03/23/2007
Last updated
04/30/2014
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