Healthcare Provider Details

I. General information

NPI: 1528974714
Provider Name (Legal Business Name): BRAINERD MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14275 EDGEWOOD DR STE 100
BAXTER MN
56425-8461
US

IV. Provider business mailing address

14275 EDGEWOOD DR STE 100
BAXTER MN
56425-8461
US

V. Phone/Fax

Practice location:
  • Phone: 218-833-5210
  • Fax: 218-833-5291
Mailing address:
  • Phone: 218-833-5210
  • Fax: 218-833-5291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEVIN BOREN
Title or Position: VP OF FINANCE
Credential:
Phone: 218-786-1009