Provider Demographics
NPI:1245280080
Name:RICE MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:RICE MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FENSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-231-4009
Mailing Address - Street 1:1801 WILLMAR AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-2882
Mailing Address - Country:US
Mailing Address - Phone:320-214-2700
Mailing Address - Fax:320-214-2765
Practice Address - Street 1:1801 WILLMAR AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-2882
Practice Address - Country:US
Practice Address - Phone:320-214-2700
Practice Address - Fax:320-214-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330432314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN585219600Medicaid
1015450OtherPREFERRED ONE PROVIDER
71-11840OtherMEDICA PROVIDER NUMBER
8659CHOtherBLUE CROSS OF MINNESOTA
NH0214OtherUCARE PROVIDER NUMBER
8659CHOtherBLUE CROSS OF MINNESOTA