Healthcare Provider Details

I. General information

NPI: 1003869082
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 SKYLINE BLVD
CLOQUET MN
55720-3787
US

IV. Provider business mailing address

512 SKYLINE BLVD
CLOQUET MN
55720-3787
US

V. Phone/Fax

Practice location:
  • Phone: 218-879-4641
  • Fax: 218-879-4641
Mailing address:
  • Phone: 218-879-4641
  • Fax: 218-879-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number331457
License Number StateMN

VIII. Authorized Official

Name: MR. RICHARD L BREUER
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 218-878-7621