MEDICARE: PINE MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	1967	MN
2	341600000X	Ambulance	0195	MN

General Provider Information

NPI Number	:	1154852937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	705 LUNDORFF DRIVE
Second Line	:
City	:	SANDSTONE
State	:	MN
Zip	:	55072-5120
Country	:	US
Telephone Number	:	320-245-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 LUNDORFF DR
Second Line	:
City	:	SANDSTONE
State	:	MN
Zip	:	55072-5099
Country	:	US
Telephone Number	:	320-245-2211
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHAEL HEDRIX
Credential	:
Telephone Number	:	320-245-5605

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	07/21/2022

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Directions to “PINE MEDICAL CENTER ” Practice Location

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