Healthcare Provider Details

I. General information

NPI: 1972539658
Provider Name (Legal Business Name): ELY-BLOOMENSON COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
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: 218-365-8788
  • Fax: 218-365-8789
Mailing address:
  • Phone: 218-365-8788
  • Fax: 218-365-8789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number262191
License Number StateMN

VIII. Authorized Official

Name: PATRICIA BANKS
Title or Position: CEO
Credential:
Phone: 218-356-8765