Healthcare Provider Details

I. General information

NPI: 1932113768
Provider Name (Legal Business Name): PERHAM HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CONEY ST W
PERHAM MN
56573-2102
US

IV. Provider business mailing address

1000 CONEY ST W
PERHAM MN
56573-2102
US

V. Phone/Fax

Practice location:
  • Phone: 218-347-4500
  • Fax: 218-346-4540
Mailing address:
  • Phone: 218-347-4500
  • Fax: 218-346-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUSTINE ANDERSON
Title or Position: VP OF FINANCE
Credential:
Phone: 218-347-1306