Basic Information
| Provider Information | |||||||||
| NPI: | 1669569265 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RANGE REGIONAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 E 34TH ST | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557463553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182624881 | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 E 34TH ST | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557463553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182624881 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 03/07/2018 | ||||||||
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| AuthorizedOfficialLastName: | FINK | ||||||||
| AuthorizedOfficialFirstName: | TOM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2183626638 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RANGE REGIONAL HEALTH SERVICES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 331001 | MN | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 107936 | 01 | MN | UCARE | OTHER | 125912 | 01 | MN | UCARE | OTHER | 35A05ME | 01 | MN | BLUE CROSS | OTHER | 98-00372 | 01 | MN | MEDICA | OTHER | P386 | 01 | MN | UCARE | OTHER | 502847723 | 05 | MN | MEDICAID | 98-00523 | 01 | MN | MEDICA | OTHER | NA920 | 01 | MN | PREFERREDONE | OTHER | 987G3ME | 01 | MN | BLUE CROSS CHIRO | OTHER | CG7247 | 01 | MN | RRPTAN | OTHER | 502847721 | 05 | MN | MEDICAID | 98-00017 | 01 | MN | MEDICA | OTHER | 98-00522 | 01 | MN | MEDICA | OTHER | 110393 | 01 | MN | UCARE | OTHER | 125913 | 01 | MN | UCARE | OTHER | 502847722 | 05 | MN | MEDICAID | 67458 | 01 | MN | HEALTH PARTNERS | OTHER | 98-00370 | 01 | MN | MEDICA | OTHER | CH5565 | 01 | MN | RRPTAN | OTHER |