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General NPI Number Information
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NPI Number | 1568418861
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH'S MEDICAL CENTER
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 138 MAIN ST S
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City | PIERZ
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State | MN
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Zip | 56364-4400
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Country | US
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Telephone | 320-468-2587
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Fax | 320-468-6219
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Provider Business Mailing Address
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Address Line | 138 MAIN ST S
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City | PIERZ
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State | MN
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Zip | 56364-4400
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Country | US
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Telephone | 320-468-2587
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Fax | 320-468-6219
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | KEVIN BOREN
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Credential |
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Telephone | 218-786-1009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 330736
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License Number State | MN
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