Provider Demographics
NPI:1578034575
Name:BRAINERD MEDICAL CENTER INC
Entity Type:Organization
Organization Name:BRAINERD MEDICAL CENTER INC
Other - Org Name:ESSENTIA HEALTH PEQUOT LAKES 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 1:30581 PATRIOT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PEQUOT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56472-4112
Mailing Address - Country:US
Mailing Address - Phone:218-568-5884
Mailing Address - Fax:218-568-8473
Practice Address - Street 1:30581 PATRIOT AVE STE A
Practice Address - Street 2:
Practice Address - City:PEQUOT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56472-4112
Practice Address - Country:US
Practice Address - Phone:218-568-5884
Practice Address - Fax:218-568-8473
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-17
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy