Provider Demographics
NPI:1023086055
Name:ST. JOSEPH'S AREA HEALTH SERVICES
Entity type:Organization
Organization Name:ST. JOSEPH'S AREA HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-732-3311
Mailing Address - Street 1:600 PLEASANT AVE S
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1431
Mailing Address - Country:US
Mailing Address - Phone:218-732-3311
Mailing Address - Fax:218-237-5585
Practice Address - Street 1:600 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1431
Practice Address - Country:US
Practice Address - Phone:218-732-3311
Practice Address - Fax:218-237-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X
MN327656282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN408045900Medicaid
MN1796HJOOtherBLUE CROSS MINNESOTA
MN1027974OtherPREFERRED ONE
MN5025417OtherMEDICA
MN60394OtherHEALTHPARTNERS
MN1M141JOOtherBLUE CROSS PROFESS FEE
MNCE9455OtherRAILROAD
MN1M141JOOtherBLUE CROSS PROFESS FEE
MN1796HJOOtherBLUE CROSS MINNESOTA
MN1M141JOOtherBLUE CROSS PROFESS FEE
MN60394OtherHEALTHPARTNERS