Provider Demographics
NPI:1477253045
Name:BRAINERD MEDICAL CENTER INC
Entity Type:Organization
Organization Name:BRAINERD MEDICAL CENTER INC
Other - Org Name:ESSENTIA HEALTH DEERWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-786-1009
Mailing Address - Street 1:1702 UNIVERSITY DR S
Mailing Address - Street 2:ATN MEDICAL STAFF SERVICES-SSC
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4940
Mailing Address - Country:US
Mailing Address - Phone:701-364-8177
Mailing Address - Fax:701-364-8476
Practice Address - Street 1:24087 CUYUNA ST
Practice Address - Street 2:STE 100
Practice Address - City:DEERWOOD
Practice Address - State:MN
Practice Address - Zip Code:56444
Practice Address - Country:US
Practice Address - Phone:218-833-5170
Practice Address - Fax:218-833-5171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-03
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy