Organization
ST. MARY'S REGIONAL HEALTH CENTER
Active
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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