Basic Information
| Provider Information | |||||||||
| NPI: | 1083758189 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICE MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 BECKER AVE SW | ||||||||
| Address2: | |||||||||
| City: | WILLMAR | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562013302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202354543 | ||||||||
| FaxNumber: | 3202314879 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 BECKER AVE SW | ||||||||
| Address2: | |||||||||
| City: | WILLMAR | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562013302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202354543 | ||||||||
| FaxNumber: | 3202314879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 07/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | HINDERKS | ||||||||
| AuthorizedOfficialFirstName: | JACLYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 3202314425 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 331093 | MN | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207P00000X | 331093 | MN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2003443 | 01 | MN | MEDICA CRNA | OTHER | 60195RI | 01 | MN | BCBS CRNA MC XOVER | OTHER | 3900629 | 01 | MN | MEDICA ER PROFESSIONAL | OTHER | H106 | 01 | MN | UCARE PROFESSIONAL | OTHER | 85817RI | 01 | MN | BCBS ER DOC | OTHER |