Healthcare Provider Details

I. General information

NPI: 1912965260
Provider Name (Legal Business Name): PAYNESVILLE AREA HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 1ST ST
PAYNESVILLE MN
56362-1445
US

IV. Provider business mailing address

200 W 1ST ST
PAYNESVILLE MN
56362-1445
US

V. Phone/Fax

Practice location:
  • Phone: 320-243-3767
  • Fax: 320-243-7519
Mailing address:
  • Phone: 320-243-3767
  • Fax: 320-243-7519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number330600
License Number StateMN

VIII. Authorized Official

Name: GREG WILSON
Title or Position: CFO/COO
Credential:
Phone: 320-243-3767