Provider Demographics
NPI:1902364482
Name:ST MARY'S REGIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:ST MARY'S REGIONAL HEALTH CENTER
Other - Org Name:ESSENTIA HEALTH ST. MARY'S-FRAZEE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-364-7667
Mailing Address - Street 1:1702 UNIVERSITY DR S
Mailing Address - Street 2:MEDICAL STAFF SERVICES-SSC
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4940
Mailing Address - Country:US
Mailing Address - Phone:701-364-8177
Mailing Address - Fax:
Practice Address - Street 1:300 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:FRAZEE
Practice Address - State:MN
Practice Address - Zip Code:56544-4504
Practice Address - Country:US
Practice Address - Phone:218-334-7255
Practice Address - Fax:218-334-4068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-04
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health