Provider Demographics
NPI:1073576906
Name:PIPESTONE COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:PIPESTONE COUNTY MEDICAL CENTER
Other - Org Name:PIPESTONE FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-825-5811
Mailing Address - Street 1:916 4TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1890
Mailing Address - Country:US
Mailing Address - Phone:507-825-5700
Mailing Address - Fax:507-825-4752
Practice Address - Street 1:916 4TH AVE SW
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1890
Practice Address - Country:US
Practice Address - Phone:507-825-5700
Practice Address - Fax:507-825-4752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2569527207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN149723500Medicaid
MN2569527OtherMINNESOTA STATE LICENSE
MN149723500Medicaid