Provider Demographics
NPI:1326045253
Name:CITY OF WHEATON
Entity Type:Organization
Organization Name:CITY OF WHEATON
Other - Org Name:WHEATON COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:TISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:320-563-8226
Mailing Address - Street 1:401 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MN
Mailing Address - Zip Code:56296-1070
Mailing Address - Country:US
Mailing Address - Phone:320-563-8226
Mailing Address - Fax:320-563-8012
Practice Address - Street 1:401 12TH ST N
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MN
Practice Address - Zip Code:56296-1070
Practice Address - Country:US
Practice Address - Phone:320-563-8226
Practice Address - Fax:320-563-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327601282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN024347700Medicaid
MN241304Medicare Oscar/Certification
MN24Z304Medicare Oscar/Certification