Healthcare Provider Details

I. General information

NPI: 1841307865
Provider Name (Legal Business Name): ST. JOSEPH'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 N 3RD ST
BRAINERD MN
56401-3054
US

IV. Provider business mailing address

523 N 3RD ST
BRAINERD MN
56401-3054
US

V. Phone/Fax

Practice location:
  • Phone: 218-828-7437
  • Fax: 218-828-7469
Mailing address:
  • Phone: 218-828-7437
  • Fax: 218-828-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number330736
License Number StateMN

VIII. Authorized Official

Name: MR. DAVID L PILOT
Title or Position: CFO
Credential:
Phone: 218-828-7642