Provider Demographics
NPI:1417105552
Name:STEVENS COMMUNITY MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:STEVENS COMMUNITY MEDICAL CENTER INC.
Other - Org Name:STARBUCK CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCEVILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-589-1313
Mailing Address - Street 1:400 E. 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267
Mailing Address - Country:US
Mailing Address - Phone:320-239-3939
Mailing Address - Fax:320-239-2802
Practice Address - Street 1:501 POLER ST
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381-2456
Practice Address - Country:US
Practice Address - Phone:320-239-3939
Practice Address - Fax:320-239-2802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVENS COMMUNITY MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-03
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center