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General NPI Number Information
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NPI Number | 1144250481
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Entity Type | Organization
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Legal Business Name | HIAWATHA MEDICAL INC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4920 MOUNDVIEW DR SUITE B
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City | RED WING
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State | MN
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Zip | 55066-1100
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Country | US
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Telephone | 651-388-2223
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Fax |
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Provider Business Mailing Address
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Address Line | 4920 MOUNDVIEW DR SUITE B
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City | RED WING
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State | MN
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Zip | 55066-1100
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Country | US
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Telephone | 651-388-2223
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. STEPHEN L STAATS
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Credential |
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Telephone | 651-388-2223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 331637
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License Number State | MN
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