Healthcare Provider Details

I. General information

NPI: 1285047498
Provider Name (Legal Business Name): PIPESTONE COUNTY MEDICAL CENTER AVERA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 4TH AVE SW SUITE 200
PIPESTONE MN
56164-1455
US

IV. Provider business mailing address

920 4TH AVE SW SUITE 200
PIPESTONE MN
56164-1455
US

V. Phone/Fax

Practice location:
  • Phone: 507-825-5811
  • Fax:
Mailing address:
  • Phone: 507-825-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY BURRIS
Title or Position: HOSPITAL ADMINISTRATOR
Credential:
Phone: 507-825-5811