Provider Demographics
NPI:1851335525
Name:NORTHERN ITASCA HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:NORTHERN ITASCA HOSPITAL DISTRICT
Other - Org Name:BIGFORK VALLEY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:SAUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-743-4115
Mailing Address - Street 1:258 PINE TREE DRIVE
Mailing Address - Street 2:P.O. BOX 258
Mailing Address - City:BIGFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56628
Mailing Address - Country:US
Mailing Address - Phone:218-743-3177
Mailing Address - Fax:218-743-3559
Practice Address - Street 1:258 PINE TREE DRIVE
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MN
Practice Address - Zip Code:56628
Practice Address - Country:US
Practice Address - Phone:218-743-3177
Practice Address - Fax:218-743-3559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331040282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1547HNOOtherBLUE CROSS
MN5025357OtherMEDICA CHOICE
MN300410OtherUCARE
MN2257OtherHEALTH PARTNERS
MN98592OtherARAZ
MN1010473OtherPREFERRED ONE
MN048545400Medicaid
MN048545400OtherIMCARE
MN361259OtherHOSPICE