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General NPI Number Information
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NPI Number | 1477253045
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Entity Type | Organization
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Legal Business Name | BRAINERD MEDICAL CENTER INC
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 24087 CUYUNA ST STE 100
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City | DEERWOOD
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State | MN
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Zip | 56444
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Country | US
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Telephone | 218-833-5170
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Fax | 218-833-5171
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Provider Business Mailing Address
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Address Line | PO BOX 518
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City | DEERWOOD
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State | MN
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Zip | 56444-0518
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Country | US
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Telephone | 218-833-5170
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Fax | 218-833-5169
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | KEVIN BOREN
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Credential |
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Telephone | 218-786-1009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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