Provider Demographics
NPI:1861636409
Name:RIVER'S EDGE HOSPITAL & CLINIC
Entity Type:Organization
Organization Name:RIVER'S EDGE HOSPITAL & CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-934-7602
Mailing Address - Street 1:1900 NORTH SUNRISE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082
Mailing Address - Country:US
Mailing Address - Phone:507-934-8480
Mailing Address - Fax:507-934-8460
Practice Address - Street 1:1900 NORTH SUNRISE DRIVE
Practice Address - Street 2:
Practice Address - City:ST PETER
Practice Address - State:MN
Practice Address - Zip Code:56082
Practice Address - Country:US
Practice Address - Phone:507-934-8480
Practice Address - Fax:507-934-8460
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVER'S EDGE HOSPITAL & CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN342725282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN650547300Medicaid
MN650547300Medicaid