Provider Demographics
NPI:1093745051
Name:JOHNSON MEMORIAL HEALTH SERVICES
Entity Type:Organization
Organization Name:JOHNSON MEMORIAL HEALTH SERVICES
Other - Org Name:JOHNSON MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-769-4323
Mailing Address - Street 1:1282 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:MN
Mailing Address - Zip Code:56232-2333
Mailing Address - Country:US
Mailing Address - Phone:320-769-4323
Mailing Address - Fax:320-769-2972
Practice Address - Street 1:1282 WALNUT ST
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:MN
Practice Address - Zip Code:56232-2333
Practice Address - Country:US
Practice Address - Phone:320-769-4323
Practice Address - Fax:320-769-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN241314Medicare ID - Type UnspecifiedMEDICARE