Organization
ESSENTIA HEALTH VIRGINIA, LLC
Active
Organization
ESSENTIA HEALTH VIRGINIA, LLC
Active
Parent organization
SMDC HEALTH SYSTEM
Other names
Essentia Health Ely Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
SMDC HEALTH SYSTEM
Authorized official
DANIEL NIKCEVICH (PRESIDENT)
(218) 786-2628
Entity
Organization
Contact information
Practice address
300 W CONAN ST, ELY, MN 55731-1145
(218) 365-7900
Mailing address
300 W CONAN ST, ELY, MN 55731-1145
(218) 365-7900
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962440362
—
MN
Enumeration date
06/04/2006
Last updated
12/13/2016
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