Custom Clinic, PA
Custom Clinic, PA is a Family Medicine Physician in Fairmont, Minnesota. Registered with an NPI since 2006.
- In the registry since
- 2006
What do these letters mean?
- PA — Professional association
- A form of business registration, not a clinical qualification.
Practice location Address checks out
322 S State St 5 Lake Center DrFairmont, MN 56031-4139
Phone: (507) 236-2880
Show map & directions
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Family Medicine Physician (primary) | Taxonomy 207Q00000X |
|---|
Record details
| NPI number | 1699859124 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Timothy Bachenberg — President · (507) 236-2880 |
| Other names | Smart Clinic |
| NPI enumerated | October 24, 2006 |
| Last updated in NPPES | August 22, 2020 |
| Mailing address | 322 S State St, 5 Lake Center Drive, Fairmont, MN 56031-4139 |
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