Healthcare Provider Details

I. General information

NPI: 1134186273
Provider Name (Legal Business Name): HEALTHEAST ST JOSEPHS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 10TH STREET WEST
SAINT PAUL MN
55102-1004
US

IV. Provider business mailing address

45 10TH STREET WEST
SAINT PAUL MN
55102-1004
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-3000
  • Fax:
Mailing address:
  • Phone: 651-232-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number331504
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number331504
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number331504
License Number StateMN

VIII. Authorized Official

Name: ROBERT ANDREW MCCOY
Title or Position: VP REVENUE MANAGEMENT
Credential:
Phone: 612-672-6594