=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770542904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELY-BLOOMENSON COMMUNITY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2006
-----------------------------------------------------
Last Update Date | 06/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 328 W CONAN ST
-----------------------------------------------------
City | ELY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55731-1145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-365-3271
-----------------------------------------------------
Fax | 218-365-8777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 328 W CONAN ST
-----------------------------------------------------
City | ELY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55731-1145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-365-3271
-----------------------------------------------------
Fax | 218-365-8777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. PATRICIA BANKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 218-365-8765
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | 327664
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------