Provider Demographics
NPI:1003214149
Name:COUNTY OF RENVILLE
Entity Type:Organization
Organization Name:COUNTY OF RENVILLE
Other - Org Name:RENVILLE COUNTY HOSPITAL - HECTOR CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-523-3477
Mailing Address - Street 1:6501 CITY WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3248
Mailing Address - Country:US
Mailing Address - Phone:952-653-2525
Mailing Address - Fax:
Practice Address - Street 1:100 HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1117
Practice Address - Country:US
Practice Address - Phone:320-523-3477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF RENVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-05
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site