Provider Demographics
NPI:1811955859
Name:PAYNESVILLE AREA HOSPITAL DISTRICT
Entity type:Organization
Organization Name:PAYNESVILLE AREA HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOBBE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-243-3767
Mailing Address - Street 1:405 MEEKER AVE E
Mailing Address - Street 2:PO BOX 529
Mailing Address - City:EDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55329-1629
Mailing Address - Country:US
Mailing Address - Phone:320-453-2260
Mailing Address - Fax:320-453-2270
Practice Address - Street 1:405 MEEKER AVE E
Practice Address - Street 2:
Practice Address - City:EDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55329-1629
Practice Address - Country:US
Practice Address - Phone:320-453-2260
Practice Address - Fax:320-453-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN905810900261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
C06929Medicare ID - Type Unspecified