1174529002 NPI number — SWIFT COUNTY-BENSON HOSPITAL

Table of content: (NPI 1174529002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174529002 NPI number — SWIFT COUNTY-BENSON HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWIFT COUNTY-BENSON HOSPITAL
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:
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:
1174529002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1815 WISCONSIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENSON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56215-1653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-843-4232
Provider Business Mailing Address Fax Number:
320-843-4172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1815 WISCONSIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENSON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56215-1653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-843-4232
Provider Business Practice Location Address Fax Number:
320-843-4172
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ENDERSON
Authorized Official First Name:
DAN
Authorized Official Middle Name:
Authorized Official Title or Position:
COFO
Authorized Official Telephone Number:
320-843-4232

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  327689 , 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: 304047000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: N004791 . This is a "TRICARE WEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1541ASW . This is a "BLUE CROSS PROV #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1541HSW . This is a "BLUE CROSS PROV #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 706112242 . This is a "PRIMEWEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5025495 . This is a "MEDICA PROV #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01013257 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 300548 . This is a "UCARE MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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