1790799518 NPI number — PERHAM HOSPITAL DISTRICT

Table of content: (NPI 1790799518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790799518 NPI number — PERHAM HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERHAM 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:
PERHAM HEALTH
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:
1790799518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 CONEY ST W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERHAM
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56573-2102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-347-4500
Provider Business Mailing Address Fax Number:
218-346-4540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 CONEY ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERHAM
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56573-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-347-4500
Provider Business Practice Location Address Fax Number:
218-346-4540
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
JUSTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
218-347-1306

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 211047400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1006086 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 300416 . This is a "UCARE OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 103925 . This is a "CHOICE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5017663 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1741 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1808HME . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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