MEDICARE: ST. JOSEPH'S MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	330736	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477509776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOSEPH'S MEDICAL CENTER

Provider Business Mailing Address
First Line	:	35205 COUNTY ROAD 3
Second Line	:
City	:	CROSSLAKE
State	:	MN
Zip	:	56442-4057
Country	:	US
Telephone Number	:	218-692-1010
Fax Number	:	218-692-1013

Provider Business Practice Location Address
First Line	:	35205 COUNTY ROAD 3
Second Line	:
City	:	CROSSLAKE
State	:	MN
Zip	:	56442-4057
Country	:	US
Telephone Number	:	218-692-1010
Fax Number	:	218-692-1013

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	KEVIN BOREN
Credential	:
Telephone Number	:	218-786-1009

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	02/27/2024

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Directions to “ST. JOSEPH'S MEDICAL CENTER ” Practice Location

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