Healthcare Provider Details

I. General information

NPI: 1578488045
Provider Name (Legal Business Name): ST JOSEPH'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14275 EDGEWOOD DR STE 150
BAXTER MN
56425-8461
US

IV. Provider business mailing address

400 E 3RD ST CREDENTIALING DEPT SSB6
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-833-5200
  • Fax: 218-829-4412
Mailing address:
  • Phone: 218-786-3167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN BOREN
Title or Position: VP OF FINANCE
Credential:
Phone: 218-786-1009