1023022803 NPI number — WINNESHIEK MEDICAL CENTER

Table of content: (NPI 1023022803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023022803 NPI number — WINNESHIEK MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINNESHIEK MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WINNESHIEK MEDICAL CENTER ANESTHESIA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023022803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 E 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACONIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55387-4552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-442-9770
Provider Business Mailing Address Fax Number:
952-442-3630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 MONTGOMERY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECORAH
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52101-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-442-9770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RADTKE
Authorized Official First Name:
LISA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CAO
Authorized Official Telephone Number:
563-387-3145

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 869T2WI . This is a "BLUE CROSS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0736561 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23199 . This is a "BLUE CROSS OF IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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