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General NPI Number Information
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NPI Number | 1669426631
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Entity Type | Organization
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Legal Business Name | GRAND ITASCA CLINIC AND HOSPITAL
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 1601 GOLF COURSE RD
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-8648
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Country | US
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Telephone | 218-326-3401
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Fax | 218-999-1461
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Provider Business Mailing Address
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Address Line | 1700 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55104-3727
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Country | US
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Telephone | 612-672-6740
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Fax | 612-884-3592
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | TODD CHRISTENSEN
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Credential |
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Telephone | 218-999-1702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number |
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 330789
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License Number State | MN
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