Organization
IVANHOE MEDICAL CENTER
Active
Organization
IVANHOE MEDICAL CENTER
Active
Parent organization
HENDRICKS CLINIC P.A.
Other names
Hendricks Clinic, P.A.
Organization subpart
Yes
Provider details
NPI number
Legal business name
HENDRICKS CLINIC P.A.
Authorized official
DR. TABB MCCLUSKEY D.O. (MEDICAL DIRECTOR)
(507) 275-2295
Entity
Organization
Contact information
Practice address
366 E GEORGE ST, IVANHOE, MN 56142-9707
(507) 694-1100
Mailing address
366 E GEORGE ST, PO BOX 43, IVANHOE, MN 56142-9707
(507) 694-1100
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1757969
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
232816000
—
MN
Enumeration date
04/19/2007
Last updated
11/27/2007
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