Provider Demographics
NPI:1154359917
Name:REGIONS HOSPITAL
Entity type:Organization
Organization Name:REGIONS HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-254-0900
Mailing Address - Street 1:PO BOX 772739
Mailing Address - Street 2:MAILSTOP 11602C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3908
Practice Address - Fax:651-254-5649
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-29
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1016468OtherPREFERRED ONE LEGACY ID
MN5009784OtherMEDICA LEGACY ID
MN21OtherHEALTHPARTNERS LEGACY ID
MN422247400Medicaid
MN113HPAOtherBLUE CROSS LEGACY ID
MN1016468OtherPREFERRED ONE LEGACY ID