Provider Demographics
NPI:1629006457
Name:REGIONS HOSPITAL
Entity Type:Organization
Organization Name:REGIONS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-254-0933
Mailing Address - Street 1:640 JACKSON ST # MS 12403A
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2502
Mailing Address - Country:US
Mailing Address - Phone:651-254-4301
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-29
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331071282N00000X
MN347856283Q00000X
MN24D0651198291U00000X
MN334638324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No283Q00000XHospitalsPsychiatric Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1132HPAOtherBLUE CROSS LEGACY ID
MN422247400Medicaid
MN1016468OtherPREFERRED ONE LEGACY ID
MN21OtherHEALTHPARTNERS LEGACY ID
MN5009784OtherMEDICA LEGACY ID
MN240106Medicare Oscar/Certification
MN24T106Medicare Oscar/Certification