1851335525 NPI number — NORTHERN ITASCA HOSPITAL DISTRICT

Table of content: (NPI 1851335525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851335525 NPI number — NORTHERN ITASCA HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN ITASCA HOSPITAL DISTRICT
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:
BIGFORK VALLEY HOSPITAL
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:
1851335525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
258 PINE TREE DRIVE
Provider Second Line Business Mailing Address:
P.O. BOX 258
Provider Business Mailing Address City Name:
BIGFORK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-743-3177
Provider Business Mailing Address Fax Number:
218-743-3559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
258 PINE TREE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIGFORK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-743-3177
Provider Business Practice Location Address Fax Number:
218-743-3559
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAUDE
Authorized Official First Name:
AARON
Authorized Official Middle Name:
CHRISTOPHER
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
218-743-4115

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  331040 , 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: 1547HNO . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5025357 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 300410 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2257 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 98592 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1010473 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 048545400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 048545400 . This is a "IMCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 361259 . This is a "HOSPICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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