MEDICARE: INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION

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	282NC0060X	Critical Access Hospital	8404773	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1691HFA	OTHER	MN	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	N002356	OTHER	MN	TRIWEST
4	5025351	OTHER	MN	MEDICA
5	01010516	OTHER	MN	PREFERRED ONE

General Provider Information

NPI Number	:	1528041183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION

Provider Business Mailing Address
First Line	:	1400 HIGHWAY 71
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2154
Country	:	US
Telephone Number	:	218-283-4481
Fax Number	:	218-283-2281

Provider Business Practice Location Address
First Line	:	1400 HIGHWAY 71
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2154
Country	:	US
Telephone Number	:	218-283-4481
Fax Number	:	218-283-2281

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROBERT PASTOR
Credential	:
Telephone Number	:	218-283-5488

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	06/02/2021

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