Provider Demographics
NPI:1316023252
Name:ST FRANCIS MEDICAL CENTER
Entity Type:Organization
Organization Name:ST FRANCIS MEDICAL CENTER
Other - Org Name:RIVERS EDGE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/VP FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-643-0402
Mailing Address - Street 1:2400 ST FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520-1025
Mailing Address - Country:US
Mailing Address - Phone:218-643-0467
Mailing Address - Fax:218-643-0865
Practice Address - Street 1:2400 ST FRANCIS DR
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1025
Practice Address - Country:US
Practice Address - Phone:218-643-0467
Practice Address - Fax:218-643-0865
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST FRANCIS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-31
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331017282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN884555700Medicaid
MN884555700Medicaid