Moose Lake Community Hospital District

Primary specialty

Critical Access HospitalTaxonomy code 282NC0060X

License

330829 Issued in MN

Legal business name

MOOSE LAKE COMMUNITY HOSPITAL DISTRICT

Doing business as

Mercy Hospital & Health Care Center

Practice address

710 S Kenwood Ave
Moose Lake, MN 55767-9405

Phone

(218) 485-4481

Fax

(218) 485-5845

NPI assigned

Oct 31, 2006

Last updated

Mar 17, 2016By the provider in NPPES

Organization subpart

No

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

Addresses

Other names 1

• Mercy Hospital & Health Care Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104902352. Details of each certification follow.

• CCN 240121 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 240121

Legal name

MERCY HOSPITAL

Certification status

Terminated Voluntary: other reason for withdrawal, Jan 1, 2004

Provider type (POS)

Hospital – Short-term

Participating since

Jul 1, 1966

Last certification

Jul 29, 1999

Beds

31

Ownership / control type

Hospital district or authority

Facility address

710 South Kenwood Avenue, Box 469
Moose Lake, MN 55767

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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Hospital & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kendra Dawn Metz, PHARMD
• Allysan L Mickle, OTR/L
• Minnesota Sex Offender Program
• Brad J Montagne, DC
• Moose Lake Community Hospital District (Mercy Hospital & Health Care Center)
• Moose Lake Community Hospital District (Mercy Home Health Agency)
• Moose Lake Community Hospital District (Mercy Hospital)
• Moose Lake Eye Care LLC
• Msocs-Moose Lake
• Jacob C Nelson, PHARMD

• Critical Access Hospital in Moose Lake, MN
• Providers in Moose Lake, MN by specialty
• Critical Access Hospital in Minnesota

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.