Healthcare Provider Details

I. General information

NPI: 1568418861
Provider Name (Legal Business Name): ST. JOSEPH'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 MAIN ST S
PIERZ MN
56364-4400
US

IV. Provider business mailing address

138 MAIN ST S
PIERZ MN
56364-4400
US

V. Phone/Fax

Practice location:
  • Phone: 320-468-2587
  • Fax: 320-468-6219
Mailing address:
  • Phone: 320-468-2587
  • Fax: 320-468-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number330736
License Number StateMN

VIII. Authorized Official

Name: KEVIN BOREN
Title or Position: VP OF FINANCE
Credential:
Phone: 218-786-1009