Organization
ST. JOSEPH'S MEDICAL CENTER
Active
Parent organization
ESSENTIA HEALTH
Other names
Essentia Health St. Joseph's-Pequot Lakes Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
ESSENTIA HEALTH
Authorized official
KEVIN BOREN (VP OF FINANCE)
(218) 786-1009
Entity
Organization
Contact information
Practice address
4317 W WOODMAN ST, PEQUOT LAKES, MN 56472-3473
(218) 568-4416
(218) 568-4625
Mailing address
4317 W WOODMAN ST, PEQUOT LAKES, MN 56472-3473
(218) 568-4416
(218) 568-4625
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
330736
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
595013900
—
MN
Enumeration date
05/24/2006
Last updated
02/27/2024
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