Provider Demographics
NPI:1538184841
Name:ST. MICHAEL'S HOSPITAL
Entity type:Organization
Organization Name:ST. MICHAEL'S HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DELANO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-352-2221
Mailing Address - Street 1:425 ELM ST N
Mailing Address - Street 2:
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378-1010
Mailing Address - Country:US
Mailing Address - Phone:320-352-2221
Mailing Address - Fax:320-352-5150
Practice Address - Street 1:425 ELM ST N
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-1010
Practice Address - Country:US
Practice Address - Phone:320-352-2221
Practice Address - Fax:320-352-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7656850251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN71512503001OtherPRIME WEST
MN3Z33MIOtherBCBS HOME
MN1011460OtherPREFERRED ONE
MN233847500Medicaid
MN5025410OtherMEDICA
MN73285OtherHEALTH PARTNERS
MN3Z32MIOtherBCBS IP
MN241522Medicare ID - Type UnspecifiedMEDICARE