Basic Information
| Provider Information | |||||||||
| NPI: | 1558328435 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLINA HEALTH SYSTEM | ||||||||
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| OtherOrganizationName: | NEW ULM MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2925 CHICAGO AVE | ||||||||
| Address2: | MR 10202 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122621166 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1324 5TH ST N | ||||||||
| Address2: | |||||||||
| City: | NEW ULM | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560731514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072331000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 10/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | FREIER | ||||||||
| AuthorizedOfficialFirstName: | TOBY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5072175108 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 331456 | MN | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 1770HSI | 01 | BCBS OF MN | OTHER | 324845300 | 05 | MN | MEDICAID | 1907 | 01 | HEALTHPARTNERS | OTHER | 50-25359 | 01 | MEDICA CHOICE | OTHER | 50-25359 | 01 | MEDICA SELECTCARE | OTHER | 01011894 | 01 | PREFERREDONE | OTHER |