Organization Name: | ST MARY'S INNOVIS HEALTH |
NPI Number: | 1730110115 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PETER J JACOBSON (PRESIDENT) |
Mailing Address: | 211 Frazee Street East Detroit Lakes |
State: | MN US |
Postal Code: | 56501 |
Phone Number: | 2188473537 |
Fax Number: | 2188474405 |
NPI Enumeration Date: | 07/05/2006 |
NPI Last Update Date: | 05/21/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 263266 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |