Provider Demographics
NPI:1174812465
Name:FIRST CARE MEDICAL SERVICES
Entity type:Organization
Organization Name:FIRST CARE MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BODENSTEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-435-7633
Mailing Address - Street 1:400 GOVERNOR STREET
Mailing Address - Street 2:
Mailing Address - City:OKLEE
Mailing Address - State:MN
Mailing Address - Zip Code:56742-0000
Mailing Address - Country:US
Mailing Address - Phone:218-796-4525
Mailing Address - Fax:
Practice Address - Street 1:400 GOVERNOR STREET
Practice Address - Street 2:
Practice Address - City:OKLEE
Practice Address - State:MN
Practice Address - Zip Code:56742-0000
Practice Address - Country:US
Practice Address - Phone:218-796-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
MN261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN381347900Medicaid
MN243464Medicare Oscar/Certification