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NPI Code Detail

MEDICARE: PINE MEDICAL CENTER

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
1261QE0002XEmergency Care Clinic/Center330737MN

General Provider Information

NPI Number : 1659459931
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINE MEDICAL CENTER
Provider Business Mailing Address
First Line : 109 COURT AVE S
Second Line :
City : SANDSTONE
State : MN
Zip : 55072-5120
Country : US
Telephone Number : 320-245-5604
Fax Number :
Provider Business Practice Location Address
First Line : 109 COURT AVE S
Second Line :
City : SANDSTONE
State : MN
Zip : 55072-5120
Country : US
Telephone Number : 320-245-5604
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : TIM ZWICKEY
Credential :
Telephone Number : 320-245-5605
Provider Enumeration Date : 11/02/2006
Last Update Date : 01/24/2008

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Directions to “PINE MEDICAL CENTER ” Practice Location

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