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General NPI Number Information
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NPI Number | 1750725586
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Entity Type | Organization
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Legal Business Name | ST. MARY'S REGIONAL HEALTH CENTER
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 117 N MAIN ST
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City | MAHNOMEN
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State | MN
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Zip | 56557-4003
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Country | US
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Telephone | 218-936-5616
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Fax |
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Provider Business Mailing Address
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Address Line | 1027 WASHINGTON AVE
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City | DETROIT LAKES
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State | MN
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Zip | 56501-3409
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Country | US
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Telephone | 218-847-5611
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Fax | 218-847-0881
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Authorized Official
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Title or Position | COO
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Name | ALAN HURLEY
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Credential |
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Telephone | 701-364-7667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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