Provider Demographics
NPI:1093102162
Name:SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC
Entity Type:Organization
Organization Name:SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC
Other - Org Name:ST JOSEPH REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:TINCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:574-948-4305
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 1:1915 LAKE AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-9366
Practice Address - Country:US
Practice Address - Phone:574-948-4305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-16
Last Update Date:2023-08-30
Deactivation Date:2021-01-26
Deactivation Code:
Reactivation Date:2023-08-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site