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Contact Information

ST MARY'S INNOVIS HEALTH
211 FRAZEE STREET EAST
DETROIT LAKES, MN56501
 Phone: 218-847-3537
 Fax: 218-847-4405
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Clinic Pharmacy

3336C0002X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for ST MARY'S INNOVIS HEALTH

NPI # 1730110115
LBN Legal business name ST MARY'S INNOVIS HEALTH
Authorized official ALAN HURLEY - (COO)
Entity Organization
Organization subpart 1 Yes
Enumeration date 07/05/2006
Last updated 07/03/2024 - More than a year ago
Identifiers
MN License # 263266
MN Medicaid 290678000
MN Other 2409995 NABP NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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