Provider Demographics
NPI:1508856683
Name:REDWOOD AREA HOSPITAL
Entity Type:Organization
Organization Name:REDWOOD AREA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYDICK
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:504-637-4511
Mailing Address - Street 1:100 FALLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283-1828
Mailing Address - Country:US
Mailing Address - Phone:507-637-4500
Mailing Address - Fax:507-697-6000
Practice Address - Street 1:100 FALLWOOD RD
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1828
Practice Address - Country:US
Practice Address - Phone:507-637-4500
Practice Address - Fax:507-697-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2013-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327688282NC0060X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24Z351Medicare Oscar/Certification