Healthcare Provider Details

I. General information

NPI: 1417105552
Provider Name (Legal Business Name): STEVENS COMMUNITY MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 POLER ST
STARBUCK MN
56381-2456
US

IV. Provider business mailing address

400 E. 1ST STREET
MORRIS MN
56267
US

V. Phone/Fax

Practice location:
  • Phone: 320-239-3939
  • Fax: 320-239-2802
Mailing address:
  • Phone: 320-239-3939
  • Fax: 320-239-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateMN

VIII. Authorized Official

Name: MRS. KERRIE MCEVILLY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 320-589-1313