Organization
ST. MARY'S REGIONAL HEALTH CENTER
Active
Other names
St. Mary's Nursing Center DME
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTY BRINKMAN III (ADMINISTRATOR)
(218) 847-0700
Entity
Organization
Contact information
Practice address
1040 LINCOLN AVE, DETROIT LAKES, MN 56501-3508
(218) 847-0820
(218) 844-0780
Mailing address
1040 LINCOLN AVE, DETROIT LAKES, MN 56501-3508
(218) 847-0820
(218) 844-0780
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
332297
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1041862
PREFERRED ONE
MN
01
—
1A755MA
BLUE CROSS BLUE SHIELD MN
MN
01
—
30393
NORTH DAKOTA MEDICAID
MN
05
—
623840800
—
MN
01
—
7122625
MEDICA
MN
Enumeration date
12/14/2006
Last updated
08/22/2020
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