Healthcare Provider Details

I. General information

NPI: 1790775864
Provider Name (Legal Business Name): REDWOOD AREA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 09/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FALLWOOD RD
REDWOOD FALLS MN
56283-1828
US

IV. Provider business mailing address

100 FALLWOOD RD
REDWOOD FALLS MN
56283-1828
US

V. Phone/Fax

Practice location:
  • Phone: 507-637-4500
  • Fax: 507-697-6000
Mailing address:
  • Phone: 507-637-4500
  • Fax: 507-697-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number327688
License Number StateMN

VIII. Authorized Official

Name: BRYAN LYDICK
Title or Position: CEO
Credential: CEO
Phone: 507-637-4511