Healthcare Provider Details

I. General information

NPI: 1750378295
Provider Name (Legal Business Name): BRAINERD LAKES SURGERY CENTER L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13114 ISLE DR
BAXTER MN
56425-8330
US

IV. Provider business mailing address

13114 ISLE DR
BAXTER MN
56425-8330
US

V. Phone/Fax

Practice location:
  • Phone: 218-822-2400
  • Fax: 218-822-2401
Mailing address:
  • Phone: 218-822-2400
  • Fax: 218-822-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number328113
License Number StateMN

VIII. Authorized Official

Name: MELISSA SCHWENDEMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 218-822-2415