MEDICARE: ST MARY'S INNOVIS HEALTH

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1265378525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST MARY'S INNOVIS HEALTH

Provider Business Mailing Address
First Line	:	101 4TH ST E
Second Line	:
City	:	PARK RAPIDS
State	:	MN
Zip	:	56470-2912
Country	:	US
Telephone Number	:	218-732-2903
Fax Number	:	218-732-6435

Provider Business Practice Location Address
First Line	:	101 4TH ST E
Second Line	:
City	:	PARK RAPIDS
State	:	MN
Zip	:	56470-2912
Country	:	US
Telephone Number	:	218-732-2903
Fax Number	:	218-732-6435

Authorized Official
Title or Position	:	COO
Name	:	ALAN JAMES HURLEY
Credential	:
Telephone Number	:	701-364-7667

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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