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General NPI Number Information
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NPI Number | 1366657025
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY HOSPITAL
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 01/29/2010
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Provider Practice Location Address
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Address Line | 415 JEFFERSON ST N
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City | WADENA
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State | MN
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Zip | 56482-1264
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Country | US
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Telephone | 218-631-7475
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Fax |
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Provider Business Mailing Address
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Address Line | 415 JEFFERSON ST N
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City | WADENA
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State | MN
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Zip | 56482-1264
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Country | US
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Telephone | 218-631-7475
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Fax |
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Authorized Official
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Title or Position | CERTIFIED ATHLETIC TRAINER
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Name | MR. PAUL WILLIAM CULLEN
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Credential | MS, ATC
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Telephone | 218-631-7475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 1566
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License Number State | MN
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