Healthcare Provider Details

I. General information

NPI: 1902364482
Provider Name (Legal Business Name): ST MARY'S REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E MAIN AVE
FRAZEE MN
56544-4504
US

IV. Provider business mailing address

1702 UNIVERSITY DR S MEDICAL STAFF SERVICES-SSC
FARGO ND
58103-4940
US

V. Phone/Fax

Practice location:
  • Phone: 218-334-7255
  • Fax: 218-334-4068
Mailing address:
  • Phone: 701-364-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALAN HURLEY
Title or Position: COO
Credential:
Phone: 701-364-7667