Healthcare Provider Details

I. General information

NPI: 1225102643
Provider Name (Legal Business Name): ST. JOSEPH'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
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

6501 CITY WEST PKWY
EDEN PRAIRIE MN
55344-3248
US

V. Phone/Fax

Practice location:
  • Phone: 952-653-2528
  • Fax:
Mailing address:
  • Phone: 952-653-2528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number330736
License Number StateMN

VIII. Authorized Official

Name: JEFF SWENSON
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 952-653-2528