Organization
ST. CLOUD EAR, NOSE & THROAT CLINIC, P.A.
Active
Other names
St. Cloud Ear, Nose & Throat - Head & Neck Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA RAE RESSEMANN (BUSINESS OFFICE MANAGER)
(320) 257-1167
Entity
Organization
Contact information
Practice address
1528 NORTHWAY DR, SAINT CLOUD, MN 56303-1255
(320) 252-0233
Mailing address
1528 NORTHWAY DR, SAINT CLOUD, MN 56303-1255
(320) 252-0233
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
508208100
—
MN
01
—
55319CL
BLUE CROSS BLUE SHIELD
MN
Enumeration date
07/14/2006
Last updated
07/03/2025
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