Provider Demographics
NPI:1699733626
Name:PAYNESVILLE AREA HOSPITAL DISTRICT
Entity type:Organization
Organization Name:PAYNESVILLE AREA HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOBBE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-243-3767
Mailing Address - Street 1:130 1ST ST NE
Mailing Address - Street 2:PO BOX 250
Mailing Address - City:RICHMOND
Mailing Address - State:MN
Mailing Address - Zip Code:56368-8183
Mailing Address - Country:US
Mailing Address - Phone:320-597-2122
Mailing Address - Fax:320-597-2102
Practice Address - Street 1:130 1ST ST NE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MN
Practice Address - Zip Code:56368-8183
Practice Address - Country:US
Practice Address - Phone:320-597-2122
Practice Address - Fax:320-597-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
C06928Medicare ID - Type Unspecified