Healthcare Provider Details

I. General information

NPI: 1255348223
Provider Name (Legal Business Name): GLACIAL RIDGE HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 PLEASANT AVENUE
BROOTEN MN
56316
US

IV. Provider business mailing address

111 PLEASANT AVENUE P.O. BOX 69
BROOTEN MN
56316
US

V. Phone/Fax

Practice location:
  • Phone: 320-346-2272
  • Fax: 320-346-2273
Mailing address:
  • Phone: 320-346-2272
  • Fax: 320-346-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KIRK STENSRUD
Title or Position: CEO
Credential:
Phone: 320-634-2208