Provider Demographics
NPI:1952484404
Name:ST MARY'S REGIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:ST MARY'S REGIONAL HEALTH CENTER
Other - Org Name:ESSENTIA HEALTH HOSPICE WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-820-4247
Mailing Address - Street 1:900 HILLIGOSS BLVD SE
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-1542
Mailing Address - Country:US
Mailing Address - Phone:218-435-7670
Mailing Address - Fax:218-435-2175
Practice Address - Street 1:900 HILLIGOSS BLVD SE
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542-1542
Practice Address - Country:US
Practice Address - Phone:218-435-7670
Practice Address - Fax:218-435-2175
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-20
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN333820251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN241564Medicare PIN