# DIVINE PROVIDENCE MEDICAL CLINIC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972660488
- **Authorized official:** MR. GREGORY WILSON (CEO)
- **Authorized official phone:** (507) 694-1414

## Contact information

- **Practice address:** 312 E GEORGE ST, IVANHOE, MN 56142-9707
- **Practice address phone:** (507) 694-1414
- **Mailing address:** 312 E GEORGE ST, IVANHOE, MN 56142-9707
- **Mailing address phone:** (507) 694-1414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC0050X | Critical Access Hospital Clinic/Center | 331042 | MN | Yes |

## Other

- **Enumeration date:** 01/03/2007
- **Last updated:** 08/22/2020