Provider Demographics
NPI:1275695397
Name:ST JOSEPH'S AREA HEALTH SERVICES
Entity Type:Organization
Organization Name:ST JOSEPH'S AREA HEALTH SERVICES
Other - Org Name:ST JOSEPH'S CARE ESSENTIALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-732-4525
Mailing Address - Street 1:1004 FIRST ST W
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-9502
Mailing Address - Country:US
Mailing Address - Phone:218-237-5760
Mailing Address - Fax:218-237-5763
Practice Address - Street 1:1004 FIRST ST W
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-9502
Practice Address - Country:US
Practice Address - Phone:218-237-5760
Practice Address - Fax:218-237-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331706332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103609JOOtherBLUE CROSS BLUE SHIELD
01029751OtherPREFERRED ONE
82-00505OtherMEDICA
MN103609JOOtherBLUE CROSS BLUE SHIELD