Basic Information
| Provider Information | |||||||||
| NPI: | 1407849367 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVER'S EDGE HOSPITAL & CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 SUNRISE DR | ||||||||
| Address2: | |||||||||
| City: | ST PETER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560825376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5079312200 | ||||||||
| FaxNumber: | 5079348505 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 SUNRISE DR | ||||||||
| Address2: | |||||||||
| City: | ST PETER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560825376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5079312200 | ||||||||
| FaxNumber: | 5079348505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 02/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | SPIKE | ||||||||
| AuthorizedOfficialFirstName: | COLLEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5079347602 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 327494 | MN | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 650547300 | 05 | MN | MEDICAID | 224267200 | 05 | MN | MEDICAID |