Organization
FERGUS FALLS MEDICAL GROUP, P.A.
Active
Parent organization
FERGUS FALLS MEDICAL GROUP, PA
Other names
Wheaton Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
FERGUS FALLS MEDICAL GROUP, PA
Authorized official
JIM WILKUS (CEO)
(218) 739-2221
Entity
Organization
Contact information
Practice address
403 12TH ST N, WHEATON, MN 56296-1070
(320) 563-8295
(320) 563-8014
Mailing address
615 S MILL ST, FERGUS FALLS, MN 56537-2756
(218) 739-2221
(218) 739-5501
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
44
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00-01587
WC MEDICA #
MN
05
—
10344
—
ND
01
—
109516
WC UCARE #
MN
01
—
62345FE
WC BCBS #
MN
Enumeration date
06/03/2006
Last updated
08/17/2018
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