Healthcare Provider Details

I. General information

NPI: 1659355600
Provider Name (Legal Business Name): SAINT ELIZABETHS HOSPITAL OF WABASHA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 GRANT BLVD W
WABASHA MN
55981-1098
US

IV. Provider business mailing address

1200 GRANT BLVD W
WABASHA MN
55981-1042
US

V. Phone/Fax

Practice location:
  • Phone: 651-565-4531
  • Fax: 651-565-2482
Mailing address:
  • Phone: 651-565-4531
  • Fax: 651-565-2482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number2005427
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN K WOLFE
Title or Position: CFO
Credential:
Phone: 651-565-5553