Provider Demographics
NPI:1154852937
Name:PINE MEDICAL CENTER
Entity Type:Organization
Organization Name:PINE MEDICAL CENTER
Other - Org Name:ESSENTIA HEALTH EMERGENCY MEDICAL SERVICES-SANDSTONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-245-5605
Mailing Address - Street 1:705 LUNDORFF DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANDSTONE
Mailing Address - State:MN
Mailing Address - Zip Code:55072-5120
Mailing Address - Country:US
Mailing Address - Phone:320-245-2211
Mailing Address - Fax:
Practice Address - Street 1:705 LUNDORFF DR
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-5099
Practice Address - Country:US
Practice Address - Phone:320-245-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARY'S DULUTH CLINIC HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0195341600000X
MN1967341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance