1144507708 NPI number — ST. MARY'S MEDICAL CENTER

Table of content: (NPI 1144507708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144507708 NPI number — ST. MARY'S MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARY'S 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:
1144507708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 KENWOOD AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55811-2370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-723-6564
Provider Business Mailing Address Fax Number:
218-723-6548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 KENWOOD AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55811-2370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-723-6564
Provider Business Practice Location Address Fax Number:
218-723-6548
Provider Enumeration Date:
11/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GARVEY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP HOSPITAL OPERATIONS
Authorized Official Telephone Number:
218-786-4878

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  355203 , 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: 0049-0050996 . This is a "MEDICA - ELDERLY WAIVER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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