Healthcare Provider Details

I. General information

NPI: 1275284374
Provider Name (Legal Business Name): INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 3RD ST
INTERNATIONAL FALLS MN
56649-2309
US

IV. Provider business mailing address

314 3RD ST
INTERNATIONAL FALLS MN
56649-2309
US

V. Phone/Fax

Practice location:
  • Phone: 218-283-3061
  • Fax: 218-520-3042
Mailing address:
  • Phone: 218-283-3061
  • Fax: 218-520-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT PASTOR
Title or Position: CEO
Credential:
Phone: 218-283-5488