Provider Demographics
NPI:1538826771
Name:CENTRAL MINNESOTA DEMENTIA COMMUNITY ACTION NETWORK
Entity type:Organization
Organization Name:CENTRAL MINNESOTA DEMENTIA COMMUNITY ACTION NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ZOOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-492-8207
Mailing Address - Street 1:7447 RIVER BEND CT
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-9327
Mailing Address - Country:US
Mailing Address - Phone:320-492-8207
Mailing Address - Fax:
Practice Address - Street 1:3701 12TH ST N STE 103
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2253
Practice Address - Country:US
Practice Address - Phone:320-640-6726
Practice Address - Fax:320-774-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty