Provider Demographics
NPI:1912083874
Name:ST. FRANCIS MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. FRANCIS MEDICAL CENTER
Other - Org Name:ST. FRANCIS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-643-0402
Mailing Address - Street 1:2400 ST FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520-1025
Mailing Address - Country:US
Mailing Address - Phone:218-643-0467
Mailing Address - Fax:218-643-0865
Practice Address - Street 1:2400 ST FRANCIS DR
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1025
Practice Address - Country:US
Practice Address - Phone:218-643-0467
Practice Address - Fax:218-643-0865
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST FRANCIS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-31
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331981251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN644747300Medicaid
MN247213Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER