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General NPI Number Information
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NPI Number | 1104988229
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Entity Type | Organization
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Legal Business Name | ST. MARY'S REGIONAL HEALTH CENTER
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1040 LINCOLN AVE
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City | DETROIT LAKES
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State | MN
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Zip | 56501-3508
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Country | US
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Telephone | 218-847-0820
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Fax | 218-844-0780
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Provider Business Mailing Address
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Address Line | 1040 LINCOLN AVE
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City | DETROIT LAKES
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State | MN
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Zip | 56501-3508
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Country | US
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Telephone | 218-847-0820
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Fax | 218-844-0780
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHRISTY BRINKMAN III
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Credential |
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Telephone | 218-847-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 332297
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License Number State | MN
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