Provider Demographics
NPI:1588764765
Name:OSSEO CLINIC, P.A.
Entity type:Organization
Organization Name:OSSEO CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-425-2117
Mailing Address - Street 1:226 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369-1245
Mailing Address - Country:US
Mailing Address - Phone:763-425-2117
Mailing Address - Fax:763-425-3935
Practice Address - Street 1:226 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1245
Practice Address - Country:US
Practice Address - Phone:763-425-2117
Practice Address - Fax:763-425-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCP7777OtherRAILROAD MEDICARE
MN111342OtherUCARE
MN4862OtherHEALTH PARTNERS
MN98340OtherPREFERRED ONE
MN13161OSOtherBLUE SHIELD
MNCP7777OtherRAILROAD MEDICARE