Provider Demographics
NPI:1043240922
Name:ST. CROIX REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:ST. CROIX REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-483-0535
Mailing Address - Street 1:235 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-4117
Mailing Address - Country:US
Mailing Address - Phone:715-483-3221
Mailing Address - Fax:715-483-0507
Practice Address - Street 1:235 STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-4117
Practice Address - Country:US
Practice Address - Phone:715-483-3221
Practice Address - Fax:715-483-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X, 225100000X, 225200000X, 225X00000X, 235Z00000X, 261QM1300X
WI1041261QU0200X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICE8643OtherRR MEDICARE CLINIC
WI1006064OtherPREFERRED ONE
WI11015000Medicaid
WI11015010Medicaid
MN196547600Medicaid
MN63Q99RIOtherBCBS MN PROFESSIONAL CHGS
WI914OtherHEALTHPARTNERS
WI5006381OtherMEDICA
WIE8643OtherRR MEDICARE HOSPITAL
MN63Q99RIOtherBCBS MN PROFESSIONAL CHGS
MN196547600Medicaid
WI1302720002Medicare NSC
WI1302720001Medicare NSC
WI=========OtherCHAMPUS TRICARE
WI11015000Medicaid
WI521337Medicare Oscar/Certification
WI1302720003Medicare NSC
MN196547600Medicaid
MN1302720004Medicare NSC