Provider Demographics
NPI:1407889991
Name:ST. MICHAEL'S HOSPITAL
Entity Type:Organization
Organization Name:ST. MICHAEL'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DELANO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-352-2221
Mailing Address - Street 1:425 ELM ST N
Mailing Address - Street 2:
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378-1010
Mailing Address - Country:US
Mailing Address - Phone:320-352-2221
Mailing Address - Fax:320-352-5150
Practice Address - Street 1:425 ELM ST N
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-1010
Practice Address - Country:US
Practice Address - Phone:320-352-2221
Practice Address - Fax:320-352-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7656850282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1011459OtherPREFERRED ONE INPATIENT
MN149444CFOtherPREFERRED CARE
MN300462OtherUCARE
WI82172800Medicaid
MN715125030OtherPRIME WEST
MN1847HMIOtherBCBS OF MINNESOTA
NC2400031Medicaid
MN8011459OtherPREFERRED ONE OUTPATIENT
IA922450Medicaid
MN233847500Medicaid
ND1472Medicaid
WA159082Medicaid
MN2126OtherHEALTH PARTNERS
MN5004648OtherMEDICA
MN613531563OtherFIRST HEALTH
NE=========-00Medicaid
NE=========-00Medicaid