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General NPI Number Information
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NPI Number | 1033180930
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Entity Type | Organization
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Legal Business Name | BROADWAY MEDICAL CENTER
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 1527 BROADWAY ST
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City | ALEXANDRIA
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State | MN
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Zip | 56308-2537
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Country | US
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Telephone | 320-762-0399
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Fax | 320-762-6847
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Provider Business Mailing Address
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Address Line | 1527 BROADWAY ST
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City | ALEXANDRIA
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State | MN
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Zip | 56308-2537
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Country | US
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Telephone | 320-762-0399
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Fax | 320-762-6847
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Authorized Official
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Title or Position | ASSISTANT ADMINISTRATOR
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Name | CHARLENE A MYREN
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Credential |
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Telephone | 320-762-6841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 590
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License Number State | MN
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