NPIMap

Organization Active NPI

Moose Lake Community Hospital District

  • Critical Access Hospital
  • Moose Lake, MN
National Provider Identifier
1104902352
Registry record updated Mar 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
330829 Issued in MN
Legal business name
MOOSE LAKE COMMUNITY HOSPITAL DISTRICT
Practice address
710 S Kenwood Ave
Moose Lake, MN 55767-9405
Phone
(218) 485-4481
Fax
(218) 485-5845
NPI assigned
Oct 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jason Douglas
Title
Chief Executive Officer
Phone
(218) 485-5858

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 330829 MN Primary

Addresses

Primary practice location

710 S Kenwood Ave
Moose Lake, MN 55767-9405

Mailing address

710 S Kenwood Ave
Moose Lake, MN 55767-9405
Phone (218) 485-4481

Other identifiers 1

IdentifierTypeStateIssuer
315245600MedicaidMN

Other names 1

  • Mercy Hospital & Health Care Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458172800000",
    "number": "1104902352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 S KENWOOD AVE",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557679405",
            "telephone_number": "218-485-4481",
            "fax_number": "218-485-5845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 S KENWOOD AVE",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557679405",
            "telephone_number": "218-485-4481",
            "fax_number": "218-485-5845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOOSE LAKE COMMUNITY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2016-03-17",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "218-485-5858"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MN",
            "license": "330829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "315245600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Hospital & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moose Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.