MEDICARE: PAYNESVILLE AREA HOSPITAL DISTRICT

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	261QC0050X	Critical Access Hospital Clinic/Center

General Provider Information

NPI Number	:	1689632689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAYNESVILLE AREA HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	308 5TH AVE S
Second Line	:
City	:	COLD SPRING
State	:	MN
Zip	:	56320-2341
Country	:	US
Telephone Number	:	320-685-7787
Fax Number	:	320-685-7793

Provider Business Practice Location Address
First Line	:	308 5TH AVE S
Second Line	:	SUITE 100
City	:	COLD SPRING
State	:	MN
Zip	:	56320-2341
Country	:	US
Telephone Number	:	320-685-7787
Fax Number	:	320-685-7793

Authorized Official
Title or Position	:	CEO
Name	:	BOBBE TEIGEN
Credential	:
Telephone Number	:	320-243-3767

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	03/29/2010

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