Provider Demographics
NPI:1578553160
Name:ST MARYS REGIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:ST MARYS REGIONAL HEALTH CENTER
Other - Org Name:ESSENTIA HEALTH OAK CROSSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-820-4247
Mailing Address - Street 1:1040 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3409
Mailing Address - Country:US
Mailing Address - Phone:218-847-0820
Mailing Address - Fax:218-844-0780
Practice Address - Street 1:1040 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3409
Practice Address - Country:US
Practice Address - Phone:218-847-0820
Practice Address - Fax:218-844-0780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-25
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328815314000000X
MN354804314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN623840800Medicaid
MN1607EMAOtherBLUE CROSS BLUE SHIELD MN
MN8Y02MAOtherBLUE CROSS BLUE SHIELD
MN7122625OtherMEDICA
8Y02MAOtherBLUE CROSS BLUE SHIE
MN7122625OtherMEDICA
8Y02MAOtherBLUE CROSS BLUE SHIE
MN8Y02MAOtherBLUE CROSS BLUE SHIELD