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CAH521329-00 ST MARYS HOSPITAL OF SUPERIOR (Active)
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Main Details
Name
ST MARYS HOSPITAL OF SUPERIOR
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH521329-00
Medicare Provider Number
521329
Additional Details
Current Program Status
Active
Registration Date
9/3/2010
Participating Start Date
9/30/2010
Participating Approval Date
9/3/2010
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Essentia Health
Bradley Beard, Chief Operating Officer
(218) 786-2652
Primary Contact
Essentia Health
Nick Sharrow, Pharmacy Business Services Director
(218) 606-9246
Addresses
Street Address
3500 TOWER AVE
SUPERIOR, WI 54880
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/09/10 ENTITY NAME WAS (ST. MARY'S HOSPITAL SUPERIOR)
09/03/2010
May 2025
May 2025
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