Organization
SOUTHWEST MINNESOTA ORTHOPEDICS AND SPORTS MEDICINE, INC
Active
Other names
Southwest Minnesota and Sports Medicine, Inc. - (Marshall)
Organization subpart
No
Provider details
NPI number
Authorized official
JODY L JACKELS RN (OFFICE MANAGER)
(507) 393-7696
Entity
Organization
Contact information
Practice address
1401 NWAKAMA ST, SUITE 300, MARSHALL, MN 56258-5529
(507) 929-7696
(507) 393-7697
Mailing address
2331 20TH ST, SLAYTON, MN 56172-1004
(507) 393-7696
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
37196
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
667522100
—
MN
Enumeration date
12/29/2006
Last updated
03/18/2010
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