1124014881 NPI number — PIPESTONE COUNTY MEDICAL CENTER

Table of content: (NPI 1124014881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124014881 NPI number — PIPESTONE COUNTY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIPESTONE COUNTY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124014881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
916 4TH AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIPESTONE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56164-1890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-825-5811
Provider Business Mailing Address Fax Number:
507-825-5733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
916 4TH AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIPESTONE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56164-1890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-825-5811
Provider Business Practice Location Address Fax Number:
507-825-5733
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BURRIS
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
507-825-5811

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  327538 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 430081 . This is a "DAKOTA HEALH PLAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 236064M . This is a "FEDERATED MUTUAL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 21041 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 824121632 . This is a "PRIMEWEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1017039 . This is a "PREFERRED ON" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1811EPI . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5025427 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8017039 . This is a "PERFEREED ONE ADM SERV" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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