Provider Demographics
NPI:1518995349
Name:REGIONS HOSPITAL
Entity type:Organization
Organization Name:REGIONS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-254-0900
Mailing Address - Street 1:PO BOX 772739
Mailing Address - Street 2:MAILSTOP 11602C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3908
Practice Address - Fax:651-254-5649
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-29
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331071273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN422247400Medicaid
MN1132HPAOtherBLUE CROSS LEGACY ID
MN5009784OtherMEDICA LEGACY ID
MN21OtherHEALTHPARTNERS LEGACY ID
MN1016468OtherPREFERRED ONE LEGACY ID
MN24T106Medicare Oscar/Certification