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General NPI Number Information
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NPI Number | 1720859531
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Entity Type | Organization
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Legal Business Name | PINE MEDICAL CENTER
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Dates
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Enumeration Date | 01/10/2024
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 45 LADY LUCK DR
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City | HINCKLEY
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State | MN
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Zip | 55037-6419
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Country | US
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Telephone | 320-279-8600
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Fax | 320-279-8601
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Provider Business Mailing Address
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Address Line | 45 LADY LUCK DR
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City | HINCKLEY
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State | MN
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Zip | 55037-6419
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Country | US
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Telephone | 320-279-8600
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Fax | 320-279-8601
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Authorized Official
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Title or Position | COO
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Name | BRADLEY BEARD
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Credential |
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Telephone | 218-786-5652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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