Healthcare Provider Details

I. General information

NPI: 1265378525
Provider Name (Legal Business Name): ST MARY'S INNOVIS HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 4TH ST E
PARK RAPIDS MN
56470-2912
US

IV. Provider business mailing address

101 4TH ST E
PARK RAPIDS MN
56470-2912
US

V. Phone/Fax

Practice location:
  • Phone: 218-732-2903
  • Fax: 218-732-6435
Mailing address:
  • Phone: 218-732-2903
  • Fax: 218-732-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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