Saint Elizabeths Hospital of Wabasha Inc
Organization Active NPI Rural Health Clinic/Center · Wabasha, MN
NPI 1477068914 · NPPES record last updated Dec 3, 2025
Key facts
- NPI
- 1477068914
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SAINT ELIZABETHS HOSPITAL OF WABASHA INC
- Practice address
- 1200 Grant Blvd W
Wabasha, MN 55981-1042 - Phone
- (651) 565-5600
- Fax
- (651) 565-5670
- NPI assigned
- Dec 6, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- SAINT ELIZABETHS HOSPITAL OF WABASHA INC
Authorized official
- Name
- John K Wolfe
- Title
- Cfo
- Phone
- (651) 565-5553
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 4
Related certifications (CCN) 1
Facilities with the same owner 49
Practitioners 93
-
Nicholas Joseph Busch, M.D.
-
Ellen K. Cales, MD
-
Kayla Dale Dascher, CNP
-
Thomas Edward Dudley, M.D.
-
Justin Christopher Dyer, M.D.
-
Jennifer J Hust, NP
-
Richard James McGeehan, M.D.
-
Nicholas L Menth, MD
-
Garrett W Shanks, MD
-
Dennis Charles Spano, M.D.
-
Amanda J Sterry, CRNA
-
Mark David Swenson, CRNA
-
Ruth J. Tiffault, DO
-
Malinda Jean Wise, MSW, LICSW
-
Mateen Fatima Abidi, M.D
-
Raju G Ailiani, MD
-
Keith Edward Baynes, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Rural health clinic certification: CCN 243484
- Legal name
- SAINT ELIZABETHS HOSPITAL OF WABASHA INC
- Doing business as
- GUNDERSEN ST ELIZABETH'S HOSPITAL AND CLINICS - WABASHA
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 30, 2018
- Last certification
- Jun 26, 2018
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 1, 1965 in MN
- Enrollment address
- 1200 Grant Blvd W
Wabasha, MN 55981-1042 - Related CCNs
- 241335
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Paul McLellan |
Corporate Director |
Jan 1, 2026 | |
| James Root |
Corporate Director |
Sep 1, 2020 | |
| W-2 Managing Employee |
Jan 1, 2007 | ||
| Richard Vaplon |
Corporate Director |
Jan 1, 2026 | |
| Bellin Gundersen Health System Inc |
5% Or Greater Indirect Ownership Interest | Nov 30, 2022 | 100% |
| Operational/Managerial Control | Nov 30, 2022 | 100% | |
| Paul R Fisch |
Corporate Director |
Sep 1, 2020 | |
| Emily Durand |
Corporate Director | Jan 1, 2023 | |
| Reece Rykal |
Corporate Director |
Jan 1, 2025 | |
| Michael J Ebersold |
Corporate Director |
Jul 1, 2016 | |
| Beverly Youngbauer |
Corporate Director | Jan 1, 2023 | |
| John K Wolfe |
Corporate Officer |
Jan 1, 1992 | |
| W-2 Managing Employee | Jan 1, 1992 | ||
| Gundersen Lutheran Health System Inc |
5% Or Greater Direct Ownership Interest | Aug 1, 2020 | 100% |
| Operational/Managerial Control | Aug 1, 2020 | 100% | |
| Cindy Denk |
Corporate Director |
Oct 1, 2012 | |
| Daniel Coenen |
Corporate Director |
Jan 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171215000803 | MN | Part a Provider - Rural Health Clinic | 5092619387 | Practice locations: Wabasha, MN |
| O20260402000230 | MN | DME Supplier - Physician - Optometrist | 5092619387 | Practice locations: Wabasha, MN |
National Provider Directory
- Tax ID family
- St Elizabeths Hosp Wabasha
- Part of
- St Elizabeths Hosp Wabasha
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
1200 Grant Blvd W
Wabasha, MN 55981-1042
Mailing address
1200 Grant Blvd W
Wabasha, MN 55981-1042
Phone (651) 565-5600
Other names
- Gundersen St. Elizabeth's Hospital and Clinics
Other providers in Wabasha, MN
- Robert J. Mann
- Ruralbasicshc Inc
- Saint Elizabeths Hospital of Wabasha Inc
- Saint Elizabeths Hospital of Wabasha Inc
- Saint Elizabeths Hospital of Wabasha Inc
- Saint Elizabeths Hospital of Wabasha Inc
- Saint Elizabeths Hospital of Wabasha Inc
- Mark Sandefur
- Amy Marie Sapola
- Nathaniel Thomas Schoen
All providers in Wabasha, MN · Rural Health Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.