Healthcare Provider Details

I. General information

NPI: 1891729802
Provider Name (Legal Business Name): REGINA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 NININGER RD
HASTINGS MN
55033-1056
US

IV. Provider business mailing address

1175 NININGER RD
HASTINGS MN
55033-1056
US

V. Phone/Fax

Practice location:
  • Phone: 651-480-4100
  • Fax: 651-480-4212
Mailing address:
  • Phone: 651-480-4100
  • Fax: 651-480-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK WILSON
Title or Position: CEO
Credential:
Phone: 651-480-4104