Healthcare Provider Details

I. General information

NPI: 1366761280
Provider Name (Legal Business Name): TRI-COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 JEFFERSON ST N
WADENA MN
56482-1264
US

IV. Provider business mailing address

6501 CITY WEST PKWY
EDEN PRAIRIE MN
55344-3248
US

V. Phone/Fax

Practice location:
  • Phone: 218-631-3510
  • Fax:
Mailing address:
  • Phone: 952-653-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: SUE ERKENBRACK
Title or Position: PHARMACY TECHNICIAN
Credential:
Phone: 952-653-2565