Healthcare Provider Details

I. General information

NPI: 1770542904
Provider Name (Legal Business Name): ELY-BLOOMENSON COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 W CONAN ST
ELY MN
55731-1145
US

IV. Provider business mailing address

328 W CONAN ST
ELY MN
55731-1145
US

V. Phone/Fax

Practice location:
  • Phone: 218-365-3271
  • Fax: 218-365-8777
Mailing address:
  • Phone: 218-365-3271
  • Fax: 218-365-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number327664
License Number StateMN

VIII. Authorized Official

Name: MS. PATRICIA BANKS
Title or Position: CEO
Credential:
Phone: 218-365-8765