Basic Information
| Provider Information | |||||||||
| NPI: | 1629006457 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REGIONS HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 JACKSON ST # MS 12403A | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551012502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512544301 | ||||||||
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| Practice Location | |||||||||
| Address1: | 640 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551012502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512543456 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | CONRAD | ||||||||
| AuthorizedOfficialFirstName: | HEIDI | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6512540933 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | REGIONS HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | 347856 | MN | N | Hospitals | Psychiatric Hospital | 291U00000X | 24D0651198 | MN | N | Laboratories | Clinical Medical Laboratory | 324500000X | 334638 | MN | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 282N00000X | 331071 | MN | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1132HPA | 01 | MN | BLUE CROSS LEGACY ID | OTHER | 422247400 | 05 | MN | MEDICAID | 1016468 | 01 | MN | PREFERRED ONE LEGACY ID | OTHER | 21 | 01 | MN | HEALTHPARTNERS LEGACY ID | OTHER | 5009784 | 01 | MN | MEDICA LEGACY ID | OTHER |