Basic Information
| Provider Information | |||||||||
| NPI: | 1780655696 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RANGE REGIONAL HEALTH SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNIVERSITY MEDICAL CENTER MESABI | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 E 34TH ST | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557463522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182624881 | ||||||||
| FaxNumber: | 2183626163 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 E 34TH ST | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557463522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182624881 | ||||||||
| FaxNumber: | 2183626163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 05/05/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KRITZ | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP/CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2183626657 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RANGE REGIONAL HEALTH SERVICES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 331001 | MN | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 1006110 | 01 | MN | PREF 1 | OTHER | 1685H CE | 01 | MN | BLUE CROSS | OTHER | 50-25402 | 01 | MN | MEDICA | OTHER | 2090 | 01 | MN | HEALTH PARTNERS | OTHER | 5021809 | 01 | MN | UBH | OTHER | 502847703 | 05 | MN | MEDICAID | 1561 | 01 | MN | HEALTH PARTNERS | OTHER | H104 300096 | 01 | MN | UCARE | OTHER |