1043240922 NPI number — ST. CROIX REGIONAL MEDICAL CENTER

Table of content: (NPI 1043240922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043240922 NPI number — ST. CROIX REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. CROIX REGIONAL 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:
Provider Other Organization Name Type Code:
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:
1043240922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
235 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CROIX FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54024-4117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-483-3221
Provider Business Mailing Address Fax Number:
715-483-0507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CROIX FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54024-4117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-483-3221
Provider Business Practice Location Address Fax Number:
715-483-0507
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOUSO
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
715-483-0535

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X , with the licence number: 1041 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 1041 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CE8643 . This is a "RR MEDICARE CLINIC" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1006064 . This is a "PREFERRED ONE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 11015000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11015010 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196547600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 63Q99RI . This is a "BCBS MN PROFESSIONAL CHGS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 914 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 5006381 . This is a "MEDICA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: E8643 . This is a "RR MEDICARE HOSPITAL" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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