# COUNTRYSIDE MEDICAL CLINIC P.L.L.C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CountrySide Medical Clinic P.L.L.C, CountrySide IV Lounge and Wellness
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730072075
- **Authorized official:** WYATT C. HAUGEN CWCA-BC, CSWS-BC (CLINIC OWNER)
- **Authorized official phone:** (320) 226-5416

## Contact information

- **Practice address:** 920 10TH ST, CLARKFIELD, MN 56223-1377
- **Practice address phone:** (320) 321-2239
- **Mailing address:** PO BOX 189, MONTEVIDEO, MN 56265-0189
- **Mailing address phone:** (320) 269-1959

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QI0500X | Infusion Therapy Clinic/Center | — | NULL | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/03/2025
- **Last updated:** 07/15/2026