Provider Demographics
NPI:1720859531
Name:PINE MEDICAL CENTER
Entity type:Organization
Organization Name:PINE MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-786-5652
Mailing Address - Street 1:45 LADY LUCK DR
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55037-6419
Mailing Address - Country:US
Mailing Address - Phone:320-279-8600
Mailing Address - Fax:320-279-8601
Practice Address - Street 1:45 LADY LUCK DR
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:MN
Practice Address - Zip Code:55037-6419
Practice Address - Country:US
Practice Address - Phone:320-279-8600
Practice Address - Fax:320-279-8601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-10
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty