Healthcare Provider Details

I. General information

NPI: 1073576906
Provider Name (Legal Business Name): PIPESTONE COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 4TH AVE SW
PIPESTONE MN
56164-1890
US

IV. Provider business mailing address

916 4TH AVE SW
PIPESTONE MN
56164-1890
US

V. Phone/Fax

Practice location:
  • Phone: 507-825-5700
  • Fax: 507-825-4752
Mailing address:
  • Phone: 507-825-5700
  • Fax: 507-825-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2569527
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2569527
License Number StateMN

VIII. Authorized Official

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