MEDICARE: EVELETH HOSPITAL, INC

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	314000000X	Skilled Nursing Facility		MN

General Provider Information

NPI Number	:	1396737417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVELETH HOSPITAL, INC

Provider Business Mailing Address
First Line	:	227 MCKINLEY AVE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1606
Country	:	US
Telephone Number	:	218-744-1950
Fax Number	:	218-744-3868

Provider Business Practice Location Address
First Line	:	227 MCKINLEY AVE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1606
Country	:	US
Telephone Number	:	218-744-1950
Fax Number	:	218-744-3868

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	JAMES Q FORSMAN
Credential	:
Telephone Number	:	218-744-1950

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	08/22/2020

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