Provider Demographics
NPI:1659355600
Name:SAINT ELIZABETHS HOSPITAL OF WABASHA INC
Entity Type:Organization
Organization Name:SAINT ELIZABETHS HOSPITAL OF WABASHA INC
Other - Org Name:GUNDERSEN ST. ELIZABETH'S HOSPITAL AND CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-565-5553
Mailing Address - Street 1:1200 GRANT BLVD W
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981-1042
Mailing Address - Country:US
Mailing Address - Phone:651-565-4531
Mailing Address - Fax:651-565-2482
Practice Address - Street 1:1200 GRANT BLVD W
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1098
Practice Address - Country:US
Practice Address - Phone:651-565-4531
Practice Address - Fax:651-565-2482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC0060X, 291U00000X, 310400000X, 3336C0003X, 3336L0003X
MN20054273336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No291U00000XLaboratoriesClinical Medical Laboratory
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5000168OtherMEDICA
2408931OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MN300302OtherUCARE FOR HOSPITAL
MN1895HELOtherBCBS FACILITY CHARGES
WI32949000Medicaid
WI11004000Medicaid
WI33160300Medicaid
MN394347000Medicaid
01007855OtherPREFERRED ONE HOSPITAL
WI32781400Medicaid
MN36181TEOtherBCBS PROFESSIONAL FEES
MN3990OtherHEALTH PARTNERS
MN60212ELOtherBCBS CRNA CHARGES
MN1895HELOtherBCBS FACILITY CHARGES
C00096Medicare Oscar/Certification
MN36181TEOtherBCBS PROFESSIONAL FEES