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Organization
COUNTRYSIDE MEDICAL CLINIC P.L.L.C
Active
Organization
COUNTRYSIDE MEDICAL CLINIC P.L.L.C
Active
Other names
CountrySide Medical Clinic P.L.L.C, CountrySide IV Lounge and Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
WYATT C. HAUGEN CWCA-BC, CSWS-BC (CLINIC OWNER)
(320) 226-5416
Entity
Organization
Contact information
Practice address
920 10TH ST, CLARKFIELD, MN 56223-1377
(320) 321-2239
Mailing address
PO BOX 189, MONTEVIDEO, MN 56265-0189
(320) 269-1959
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
NULL
261QI0500X
Infusion Therapy Clinic/Center
—
NULL
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
06/03/2025
Last updated
07/15/2026
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