Basic Information
Provider Information | |||||||||
NPI: | 1538143896 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CUYUNA REGIONAL MEDICAL CENTER | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 320 E MAIN ST | ||||||||
Address2: |   | ||||||||
City: | CROSBY | ||||||||
State: | MN | ||||||||
PostalCode: | 564411645 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2185467000 | ||||||||
FaxNumber: | 2185464645 | ||||||||
Practice Location | |||||||||
Address1: | 320 E MAIN ST | ||||||||
Address2: |   | ||||||||
City: | CROSBY | ||||||||
State: | MN | ||||||||
PostalCode: | 564411645 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2185467000 | ||||||||
FaxNumber: | 2185464645 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/01/2005 | ||||||||
LastUpdateDate: | 01/04/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BERG | ||||||||
AuthorizedOfficialFirstName: | KATIE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 2185467000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/04/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X |   |   | Y |   | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
ID | Type | State | Issuer | Description | 1598HCU | 01 | MN | BLUE CROSS BLUE SHIELD MN | OTHER | 01011304 | 01 | MN | PREFERRED ONE | OTHER | 300376 | 01 | MN | UCARE | OTHER | 5011807 | 01 | MN | MEDICA | OTHER | 535845100 | 05 | MN |   | MEDICAID | 9289 | 01 | MN | HEALTH PARTNERS | OTHER | CT0955 | 01 | MN | RAILROAD MEDICARE | OTHER |