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General NPI Number Information
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NPI Number | 1750378295
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Entity Type | Organization
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Legal Business Name | BRAINERD LAKES SURGERY CENTER L L C
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 13114 ISLE DR
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City | BAXTER
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State | MN
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Zip | 56425-8330
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Country | US
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Telephone | 218-822-2400
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Fax | 218-822-2401
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Provider Business Mailing Address
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Address Line | 13114 ISLE DR
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City | BAXTER
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State | MN
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Zip | 56425-8330
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Country | US
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Telephone | 218-822-2400
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Fax | 218-822-2401
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MELISSA SCHWENDEMAN
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Credential |
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Telephone | 218-822-2415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 328113
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License Number State | MN
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