Provider Demographics
NPI:1295789352
Name:WINONA HEALTH SERVICES
Entity type:Organization
Organization Name:WINONA HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-457-4300
Mailing Address - Street 1:855 MANKATO AVE
Mailing Address - Street 2:PO BOX 5600
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5377
Mailing Address - Country:US
Mailing Address - Phone:507-454-3650
Mailing Address - Fax:
Practice Address - Street 1:855 MANKATO AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5377
Practice Address - Country:US
Practice Address - Phone:507-454-3650
Practice Address - Fax:507-457-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN208D00000X
MN331049282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN38040COOtherBLUE SHIELD PHYS
MN1928HCOOtherBLUE CROSS PROV #
WI11004400Medicaid
MN124847200Medicaid
MNCE1794OtherMEDICARE RAILROAD
MN00113Medicare ID - Type UnspecifiedPHYSICIAN GROUP
MN124847200Medicaid