Provider Demographics
NPI:1922287127
Name:CITY OF WHEATON
Entity Type:Organization
Organization Name:CITY OF WHEATON
Other - Org Name:WHEATON COMMUNITY HOSPITAL & MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-563-8226
Mailing Address - Street 1:401 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MN
Mailing Address - Zip Code:56296-1070
Mailing Address - Country:US
Mailing Address - Phone:320-563-8971
Mailing Address - Fax:
Practice Address - Street 1:401 12TH ST N
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MN
Practice Address - Zip Code:56296-1070
Practice Address - Country:US
Practice Address - Phone:320-563-8971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN243435261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN187968000Medicaid
MN243435Medicare Oscar/Certification