Provider Demographics
| NPI: | 1043240922 |
|---|---|
| Name: | ST. CROIX REGIONAL MEDICAL CENTER |
| Entity Type: | Organization |
| Organization Name: | ST. CROIX REGIONAL MEDICAL CENTER |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | MIKE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | YOUSO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 715-483-0535 |
| Mailing Address - Street 1: | 235 E STATE ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SAINT CROIX FALLS |
| Mailing Address - State: | WI |
| Mailing Address - Zip Code: | 54024-4117 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 715-483-3221 |
| Mailing Address - Fax: | 715-483-0507 |
| Practice Address - Street 1: | 235 STATE ST |
| Practice Address - Street 2: | |
| Practice Address - City: | SAINT CROIX FALLS |
| Practice Address - State: | WI |
| Practice Address - Zip Code: | 54024-4117 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 715-483-3221 |
| Practice Address - Fax: | 715-483-0507 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-07-04 |
| Last Update Date: | 2023-02-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 224Z00000X, 225100000X, 225200000X, 225X00000X, 235Z00000X, 261QM1300X | ||
| WI | 1041 | 261QU0200X, 282NC0060X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 282NC0060X | Hospitals | General Acute Care Hospital | Critical Access | |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Single Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Single Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Single Specialty |
| No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| WI | CE8643 | Other | RR MEDICARE CLINIC |
| WI | 1006064 | Other | PREFERRED ONE |
| WI | 11015000 | Medicaid | |
| WI | 11015010 | Medicaid | |
| MN | 196547600 | Medicaid | |
| MN | 63Q99RI | Other | BCBS MN PROFESSIONAL CHGS |
| WI | 914 | Other | HEALTHPARTNERS |
| WI | 5006381 | Other | MEDICA |
| WI | E8643 | Other | RR MEDICARE HOSPITAL |
| MN | 63Q99RI | Other | BCBS MN PROFESSIONAL CHGS |
| MN | 196547600 | Medicaid | |
| WI | 1302720002 | Medicare NSC | |
| WI | 1302720001 | Medicare NSC | |
| WI | ========= | Other | CHAMPUS TRICARE |
| WI | 11015000 | Medicaid | |
| WI | 521337 | Medicare Oscar/Certification | |
| WI | 1302720003 | Medicare NSC | |
| MN | 196547600 | Medicaid | |
| MN | 1302720004 | Medicare NSC |
