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General NPI Number Information
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NPI Number | 1255348223
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Entity Type | Organization
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Legal Business Name | GLACIAL RIDGE HOSPITAL DISTRICT
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 111 PLEASANT AVENUE
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City | BROOTEN
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State | MN
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Zip | 56316
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Country | US
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Telephone | 320-346-2272
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Fax | 320-346-2273
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Provider Business Mailing Address
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Address Line | 111 PLEASANT AVENUE P.O. BOX 69
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City | BROOTEN
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State | MN
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Zip | 56316
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Country | US
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Telephone | 320-346-2272
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Fax | 320-346-2273
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Authorized Official
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Title or Position | CEO
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Name | KIRK STENSRUD
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Credential |
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Telephone | 320-634-2208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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