Provider Demographics
NPI:1568877462
Name:ST JOSEPHS MEDICAL CENTER
Entity Type:Organization
Organization Name:ST JOSEPHS MEDICAL CENTER
Other - Org Name:ESSENTIA HEALTH - ST JOSEPH'S EMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-828-7110
Mailing Address - Street 1:6501 CITY WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3248
Mailing Address - Country:US
Mailing Address - Phone:952-653-2525
Mailing Address - Fax:
Practice Address - Street 1:20918 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:EMILY
Practice Address - State:MN
Practice Address - Zip Code:56447-4045
Practice Address - Country:US
Practice Address - Phone:218-828-7110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JOSEPHS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site