Provider Demographics
NPI:1023022803
Name:WINNESHIEK MEDICAL CENTER
Entity Type:Organization
Organization Name:WINNESHIEK MEDICAL CENTER
Other - Org Name:WINNESHIEK MEDICAL CENTER ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RADTKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-387-3145
Mailing Address - Street 1:400 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:952-442-9770
Mailing Address - Fax:952-442-3630
Practice Address - Street 1:901 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2325
Practice Address - Country:US
Practice Address - Phone:952-442-9770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN869T2WIOtherBLUE CROSS OF MN
IA0736561Medicaid
IA23199OtherBLUE CROSS OF IOWA
IADF1435Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IAI18271Medicare ID - Type UnspecifiedIOWA MEDICARE