1295789352 NPI number — WINONA HEALTH SERVICES

Table of content: (NPI 1295789352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295789352 NPI number — WINONA HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINONA HEALTH SERVICES
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:
WINONA COMMUNITY MEMORIAL HOSPITAL
Provider Other Organization Name Type Code:
4
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:
1295789352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
855 MANKATO AVE
Provider Second Line Business Mailing Address:
PO BOX 5600
Provider Business Mailing Address City Name:
WINONA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55987-5377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-454-3650
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 MANKATO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINONA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55987-5377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-454-3650
Provider Business Practice Location Address Fax Number:
507-457-4413
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTZ
Authorized Official First Name:
RACHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
507-457-4300

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 331049 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38040CO . This is a "BLUE SHIELD PHYS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1928HCO . This is a "BLUE CROSS PROV #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 11004400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 124847200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CE1794 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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