Provider Demographics
NPI:1740240225
Name:SIBLEY MEDICAL CENTER
Entity Type:Organization
Organization Name:SIBLEY MEDICAL CENTER
Other - Org Name:RIDGEVIEW SIBLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-442-2191
Mailing Address - Street 1:601 WEST CHANDLER STREET
Mailing Address - Street 2:P.O. BOX 620
Mailing Address - City:ARLINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55307-0620
Mailing Address - Country:US
Mailing Address - Phone:507-964-2271
Mailing Address - Fax:507-964-8490
Practice Address - Street 1:601 WEST CHANDLER STREET
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MN
Practice Address - Zip Code:55307-0620
Practice Address - Country:US
Practice Address - Phone:507-964-2271
Practice Address - Fax:507-964-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN241311282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN513547800Medicaid
MN24-1311Medicare Oscar/Certification