| Organization Name: | ST. JOSEPH'S MEDICAL CENTER |
| NPI Number: | 1649223603 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID L PILOT (CFO) |
| Mailing Address: | 415 Barclay Ave Pine River |
| State: | MN US |
| Postal Code: | 564745139 |
| Phone Number: | 2185874416 |
| Fax Number: | 2185872677 |
| NPI Enumeration Date: | 05/18/2006 |
| NPI Last Update Date: | 12/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 330736 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |