1245395409 NPI number — AITKIN COMMUNITY HOSPITAL, INC.

Table of content: (NPI 1245395409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245395409 NPI number — AITKIN COMMUNITY HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AITKIN COMMUNITY HOSPITAL, INC.
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:
RIVERWOOD HEALTHCARE CENTER
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:
1245395409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 BUNKER HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AITKIN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56431-1865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-927-2157
Provider Business Mailing Address Fax Number:
218-927-4130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 E CENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCGREGOR
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-768-4011
Provider Business Practice Location Address Fax Number:
218-768-4814
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WESTMAN
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
218-927-5501

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 120128 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 47305 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 139018000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39A31RI . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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