Provider Demographics
NPI:1740325919
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:2007-02-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN335388275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5025417OtherMEDICA
MN1796HJOOtherBLUE CROSS OF MN
MN1M141JOOtherBLUE SHIELD PROFESS FEES
MN60394OtherHEALTHPARTNERS
MN1027974OtherPREFERRED ONE
MNCE9455OtherMEDICARE RAILROAD
MN1027974OtherPREFERRED ONE
MN1027974OtherPREFERRED ONE
MN1796HJOOtherBLUE CROSS OF MN
MN24Z380Medicare Oscar/Certification