Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Custom Clinic, PA

Organization Family Medicine Physician · NPI 1699859124

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.

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Practice location Address checks out

322 S State St 5 Lake Center Dr
Fairmont, MN 56031-4139
Phone: (507) 236-2880
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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 number1699859124
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Timothy Bachenberg — President · (507) 236-2880
Other names Smart Clinic
NPI enumeratedOctober 24, 2006
Last updated in NPPESAugust 22, 2020
Mailing address322 S State St, 5 Lake Center Drive, Fairmont, MN 56031-4139

Other providers in Fairmont