Provider Demographics
NPI:1508378324
Name:INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:RAINY LAKE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-283-5488
Mailing Address - Street 1:1400 HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2154
Mailing Address - Country:US
Mailing Address - Phone:218-283-4481
Mailing Address - Fax:218-283-2281
Practice Address - Street 1:912 MAIN ST UNIT C
Practice Address - Street 2:
Practice Address - City:LITTLEFORK
Practice Address - State:MN
Practice Address - Zip Code:56653-9379
Practice Address - Country:US
Practice Address - Phone:218-278-2000
Practice Address - Fax:218-278-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN243987OtherMEDICARE