Provider Demographics
NPI:1144226226
Name:ORDER OF ST. BENEDICT
Entity Type:Organization
Organization Name:ORDER OF ST. BENEDICT
Other - Org Name:ST. JOHN'S UNIVERSITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH CENTER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:JOHANNA
Authorized Official - Last Name:HAEG
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:320-363-3142
Mailing Address - Street 1:112 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56321-7777
Mailing Address - Country:US
Mailing Address - Phone:320-363-3142
Mailing Address - Fax:320-363-3124
Practice Address - Street 1:112 ABBEY RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:MN
Practice Address - Zip Code:56321-7777
Practice Address - Country:US
Practice Address - Phone:320-363-3142
Practice Address - Fax:320-363-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN55326JOOtherBCBS
MNC07636Medicare PIN