1639162381 NPI number — ST. FRANCIS MEDICAL CENTER

Table of content: MR. JACOB L. PRICE LPC (NPI 1417437898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639162381 NPI number — ST. FRANCIS MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. FRANCIS 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:
6
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:
1639162381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 ST. FRANCIS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRECKENRIDGE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-643-3000
Provider Business Mailing Address Fax Number:
218-643-0870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 ST. FRANCIS DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRECKENRIDGE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-643-3000
Provider Business Practice Location Address Fax Number:
218-643-0870
Provider Enumeration Date:
08/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
JAY
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
VP OF FINANCE OPERATION
Authorized Official Telephone Number:
218-616-3525

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 331017 , 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: 01074 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1556HFR . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5017662 . This is a "MEDICA PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 644747300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2136 . This is a "HEALTH PARTNERS PROV. #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com