Organization
HENDRICKS CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TABB L MCCLUSKEY DO (OWNER PRESIDENT)
(507) 275-3121
Entity
Organization
Contact information
Practice address
501 E LINCOLN ST, HENDRICKS, MN 56136-0026
(507) 275-3121
(507) 275-3194
Mailing address
501 E LINCOLN ST, PO BOX 26, HENDRICKS, MN 56136-0026
(507) 275-3121
(507) 275-3194
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
1757969
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
232816000
—
MN
Enumeration date
07/10/2006
Last updated
12/28/2009
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