MEDICARE: PINE MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NC0060X	Critical Access Hospital	361349	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	22454NO	OTHER	MN	BCBS OF MINNESOTA ER
3	3945005	OTHER	MN	MEDICA ER
4	36F55PI	OTHER	MN	BCBS OF MINNESOTA UC
5	58444	OTHER	MN	HEALTH PARTNERS
6	01006123	OTHER	MN	PREFERRED ONE ER
7	1033994	OTHER	MN	PREFERRED ONE UC
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	6604104	OTHER	MN	MEDICA URGENT CARE
10	H109	OTHER	MN	UCARE ER
11	5013818	OTHER	MN	MEDICA UB
12	F793	OTHER	MN	UCARE UC
13	300142	OTHER	MN	UCARE AMBULANCE
14	3B24HPI	OTHER	MN	BCBS OF MINNESOTA UB

General Provider Information

NPI Number	:	1326041633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE MEDICAL CENTER

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

Provider Business Practice Location Address
First Line	:	705 LUNDORFF DRIVE SOUTH
Second Line	:
City	:	SANDSTONE
State	:	MN
Zip	:	55072
Country	:	US
Telephone Number	:	320-245-2212
Fax Number	:	320-245-3251

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	MR. KEVIN BOREN
Credential	:
Telephone Number	:	218-786-1009

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/27/2024

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Directions to “PINE MEDICAL CENTER ” Practice Location

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