Provider Demographics
NPI:1528041183
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 1:1400 HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2154
Practice Address - Country:US
Practice Address - Phone:218-283-4481
Practice Address - Fax:218-283-2281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8404773282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1691HFAOtherBLUE CROSS
MN468845700Medicaid
MNN002356OtherTRIWEST
MN5025351OtherMEDICA
MN01010516OtherPREFERRED ONE
IL=========001Medicaid
MN5025351OtherMEDICA
MN241322Medicare Oscar/Certification