Provider Demographics
NPI:1386682045
Name:ESSENTIA HEALTH VIRGINIA, LLC
Entity Type:Organization
Organization Name:ESSENTIA HEALTH VIRGINIA, LLC
Other - Org Name:ESSENTIA HEALTH INTERNATIONAL FALLS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-742-8662
Mailing Address - Street 1:2501 KEENAN DR
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2181
Mailing Address - Country:US
Mailing Address - Phone:218-283-9431
Mailing Address - Fax:
Practice Address - Street 1:2501 KEENAN DR
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2181
Practice Address - Country:US
Practice Address - Phone:218-283-9431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMDC HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-03
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC08259Medicare PIN
MNC09302Medicare PIN
0440980012Medicare NSC