Organization
APPLE VALLEY MEDICAL CLINIC, LTD.
Active
Parent organization
APPLE VALLEY MEDICAL CLINIC, LTD.
Other names
Apple Valley Medical Center Sleep Lab
Organization subpart
Yes
Provider details
NPI number
Legal business name
APPLE VALLEY MEDICAL CLINIC, LTD.
Authorized official
MARK POTTENGER (ADMINISTRATOR)
(952) 953-9285
Entity
Organization
Contact information
Practice address
15100 GALAXIE AVE, APPLE VALLEY, MN 55124
(952) 432-6161
(952) 891-3921
Mailing address
14655 GALAXIE AVE, APPLE VALLEY, MN 55124
(952) 432-6161
(952) 891-3921
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
723
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22345AP
BCBS
—
01
—
5CB22AP
BCBS
—
Enumeration date
10/21/2010
Last updated
06/19/2017
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