Organization
APPLE VALLEY MEDICAL CLINIC, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY WASSON (SYSTEMS MANAGER/SECURITY OFFICER)
(952) 997-9313
Entity
Organization
Contact information
Practice address
14655 GALAXIE AVE, APPLE VALLEY, MN 55124
(952) 432-6161
(952) 432-7019
Mailing address
14655 GALAXIE AVE, APPLE VALLEY, MN 55124-8575
(952) 432-6161
(952) 432-7019
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
723
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22345AP
BLUE CROSS BLUE SHIELD
MN
01
—
55108
HEALTHPARTNERS UC
MN
01
—
587
HEALTHPARTNERS
MN
05
—
594010900
—
MN
01
—
6792510001
MEDICARE
MN
01
—
858098
PREFERRED ONE
MN
05
—
989883200
—
MN
01
—
C00152
PTAN
—
01
—
CE7163
MEDICARE RAILROAD
MN
Enumeration date
06/22/2006
Last updated
06/11/2018
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