1326041633 NPI number — PINE MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326041633 NPI number — PINE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINE 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:
6
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:
1326041633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 LUNDORFF DRIVE SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDSTONE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-245-2212
Provider Business Mailing Address Fax Number:
320-245-3251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 LUNDORFF DRIVE SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDSTONE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-245-2212
Provider Business Practice Location Address Fax Number:
320-245-3251
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOREN
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
218-786-1009

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  361349 , 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: 1326041633 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22454NO . This is a "BCBS OF MINNESOTA ER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3945005 . This is a "MEDICA ER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 36F55PI . This is a "BCBS OF MINNESOTA UC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 58444 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01006123 . This is a "PREFERRED ONE ER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1033994 . This is a "PREFERRED ONE UC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1326041633 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6604104 . This is a "MEDICA URGENT CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: H109 . This is a "UCARE ER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5013818 . This is a "MEDICA UB" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: F793 . This is a "UCARE UC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 300142 . This is a "UCARE AMBULANCE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3B24HPI . This is a "BCBS OF MINNESOTA UB" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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