Healthcare Provider Details

I. General information

NPI: 1891862702
Provider Name (Legal Business Name): RICE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 BECKER AVE SW
WILLMAR MN
56201-3302
US

IV. Provider business mailing address

301 BECKER AVE SW
WILLMAR MN
56201-3302
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-8740
  • Fax: 320-231-8741
Mailing address:
  • Phone: 320-231-8740
  • Fax: 320-231-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number128943-5
License Number StateMN

VIII. Authorized Official

Name: LISA BOLLE
Title or Position: DIABETES CLINICAL NURSE SPECIALIST
Credential: RN, CNS
Phone: 320-231-8740