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General NPI Number Information
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NPI Number | 1578488045
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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 | 08/12/2026
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 14275 EDGEWOOD DR STE 150
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City | BAXTER
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State | MN
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Zip | 56425-8461
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Country | US
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Telephone | 218-833-5200
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Fax | 218-829-4412
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Provider Business Mailing Address
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Address Line | 400 E 3RD ST CREDENTIALING DEPT SSB6
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City | DULUTH
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State | MN
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Zip | 55805-1951
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Country | US
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Telephone | 218-786-3167
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Fax |
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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