Basic Information
| Provider Information | |||||||||
| NPI: | 1740240225 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SIBLEY MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RIDGEVIEW SIBLEY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 WEST CHANDLER STREET | ||||||||
| Address2: | P.O. BOX 620 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553070620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5079642271 | ||||||||
| FaxNumber: | 5079648490 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 WEST CHANDLER STREET | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553070620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5079642271 | ||||||||
| FaxNumber: | 5079648490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 04/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | PHELPS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9524422191 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 241311 | MN | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 513547800 | 05 | MN | MEDICAID |