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ESSENTIA HEALTH ST. JOSEPH'S-PEQUOT LAKES CLINIC
NPI 1730134891
Clinic/Center - Primary Care in Pequot Lakes, MN

Active since May 24, 2006CLIA 24D0682150 · Waiver
4317 W WOODMAN ST, PEQUOT LAKES, MN 56472(218) 568-4416(218) 568-4625 Get Directions Write a Review

NPPES record last updated: February 27, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Essentia Health St. Joseph's-pequot Lakes Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ESSENTIA HEALTH ST. JOSEPH'S-PEQUOT LAKES CLINIC (NPI 1730134891) is a healthcare organization registered as a primary care in Pequot Lakes, Minnesota and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through September 7, 2027 and lists Kevin Boren, Vp Of Finance, as its authorized official.

NPPES Registry Identity

NPI1730134891
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameST. JOSEPH'S MEDICAL CENTER
Location Address4317 W WOODMAN STPequot Lakes, MN 56472-3473
Mailing Address4317 W Woodman StPequot Lakes, MN 56472-3473 · (218) 568-4416 · Fax (218) 568-4625
Phone(218) 568-4416
Fax(218) 568-4625
Organization SubpartYesParent: Essentia Health
Authorized OfficialKevin BorenVp Of Finance · (218) 786-1009
Enumeration DateMay 24, 2006
Last NPPES UpdateFebruary 27, 2024
NPPES CertifiedFebruary 27, 2024
✔ NPI 1730134891 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in MN · 330736
4317 W WOODMAN ST, Pequot Lakes, MN 56472
Open in Google Maps ↗

Other Names 1

Doing Business AsEssentia Health St. Joseph's-pequot Lakes Clinic

Other Identifiers 1

Medicaid595013900MN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Medica, Sanford Health Plan.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D0682150

Essentia Health St Josephs - Pequot Lakes Clinic · Pequot Lakes, MN
Active · expires Sep 7, 2027
CLIA Number24D0682150
Laboratory TypePhysician Office
Certificate Effective DateSeptember 8, 2025
Certificate Expiration DateSeptember 7, 2027
Laboratory DirectorDanielle Ashcroft
Laboratory Phone(218) 568-4416
Laboratory LocationEssentia Health St Josephs - Pequot Lakes Clinic4317 W Woodman St, Pequot Lakes, MN 56472
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PAYDEN STRANGE
Physician Assistant
4317 W WOODMAN ST
PEQUOT LAKES, MN 56472
Crow Wing County (218) 568-4416
KELLY A SPRAY CNP
Nurse Practitioner (Family)
4317 W WOODMAN ST
PEQUOT LAKES, MN 56472
Crow Wing County (218) 568-4416
BRETT P NIENABER MD
Family Medicine
4317 W WOODMAN ST
PEQUOT LAKES, MN 56472
Crow Wing County (218) 568-4416

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is St. Joseph's Medical Center's NPI number?

The NPI number for St. Joseph's Medical Center is 1730134891. It was assigned to this organization in the NPPES registry on May 24, 2006. The provider is doing business as Essentia Health St. Joseph's-Pequot Lakes Clinic.

Where is St. Joseph's Medical Center located?

St. Joseph's Medical Center is located at 4317 W Woodman St, Pequot Lakes, MN 56472. The listed phone number is (218) 568-4416.

What is St. Joseph's Medical Center's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does St. Joseph's Medical Center hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D0682150) is associated with this NPI, valid through September 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does St. Joseph's Medical Center accept?

Health plans from Medica and Sanford Health Plan list St. Joseph's Medical Center as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for St. Joseph's Medical Center was last updated on February 27, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.