Basic Information
| Provider Information | |||||||||
| NPI: | 1255516977 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REGINA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 NININGER RD | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550331056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514804100 | ||||||||
| FaxNumber: | 6514804490 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 NININGER RD | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550331056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514804100 | ||||||||
| FaxNumber: | 6514804490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2007 | ||||||||
| LastUpdateDate: | 12/31/2007 | ||||||||
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| AuthorizedOfficialLastName: | ENCK | ||||||||
| AuthorizedOfficialFirstName: | ERNEST | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6514804116 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CEO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | MN20888 | MN | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.