MEDICARE: ESSENTIA HEALTH VIRGINIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	327573	MN

General Provider Information

NPI Number	:	1083617120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIA HEALTH VIRGINIA, LLC

Provider Business Mailing Address
First Line	:	901 9TH ST N
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792
Country	:	US
Telephone Number	:	218-741-3340
Fax Number	:	218-749-7955

Provider Business Practice Location Address
First Line	:	901 9TH ST N
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-2325
Country	:	US
Telephone Number	:	218-741-3340
Fax Number	:	218-749-9427

Authorized Official
Title or Position	:	COO
Name	:	SAMUEL STONE
Credential	:
Telephone Number	:	218-749-9496

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/07/2022

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