Healthcare Provider Details

I. General information

NPI: 1730248907
Provider Name (Legal Business Name): MINNESOTA VALLEY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S 4TH ST
LE SUEUR MN
56058-2203
US

IV. Provider business mailing address

621 S 4TH ST
LE SUEUR MN
56058-2203
US

V. Phone/Fax

Practice location:
  • Phone: 507-665-3375
  • Fax: 507-665-2191
Mailing address:
  • Phone: 507-665-3375
  • Fax: 507-665-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number24Z375
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number00336
License Number StateMN

VIII. Authorized Official

Name: MICHAEL PHELPS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 952-442-2191