Organization
DIVINE PROVIDENCE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY WILSON (CEO)
(507) 694-1414
Entity
Organization
Contact information
Practice address
312 E GEORGE ST, IVANHOE, MN 56142-9707
(507) 694-1414
Mailing address
312 E GEORGE ST, IVANHOE, MN 56142-9707
(507) 694-1414
Taxonomy
Speciality
Code
Description
License number
State
261QC0050X
Critical Access Hospital Clinic/Center
Primary
331042
MN
Other
Enumeration date
01/03/2007
Last updated
08/22/2020
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