Provider Demographics
NPI:1306873872
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:
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 1:435 PHALEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
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:2006-06-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331071282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN30250OtherHEALTHPARTNERS SURGERY
MN240106Medicare PIN