Healthcare Provider Details

I. General information

NPI: 1255498432
Provider Name (Legal Business Name): CANNON FALLS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 MILL ST W
CANNON FALLS MN
55009-1824
US

IV. Provider business mailing address

2556 YELLOWSTONE RD
HASTINGS MN
55033-3751
US

V. Phone/Fax

Practice location:
  • Phone: 507-263-4221
  • Fax:
Mailing address:
  • Phone: 651-253-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number1957
License Number StateMN

VIII. Authorized Official

Name: MS. ELIZABETH ANN NIEBUR
Title or Position: ATHLETIC TRAINER
Credential: MA, ATC
Phone: 651-253-4118