St. Croix Family Medical Clinic

LBN: Southside Community Health Services, Inc.
St. Croix Family Medical Clinic is an health care organization with primary practice located at 5640 Memorial Ave N Suite B, Stillwater MN 55082-2166. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Southside Community Health Services, Inc. can be contacted via phone (651) 430-1880, or through Tendle, William Henry via phone (612) 821-2800.

Contact Information

Primary practice address
5640 Memorial Ave N Suite B Stillwater MN 55082-2166
Phone: (651) 430-1880
Fax: (651) 430-1323
Website:
Map and Directions
Authorized official contact:
Name: Tendle, William Henry
Phone: (612) 821-2800

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X

Profile Details

NPI number 1578680872
LBN Legal business name Southside Community Health Services, Inc.
DBA Doing business as St. Croix Family Medical Clinic
Authorized official Tendle, William Henry
Entity Organization
Organization subpart 1 No
Enumeration date Mar 23rd, 2007
Last updated Apr 30th, 2014 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578680872 NPPES
Minnesota MEDICAID 943170500

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