Provider Demographics
NPI:1598751240
Name:PIPESTONE COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:PIPESTONE COUNTY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:D
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:507-825-5811
Mailing Address - Fax:507-825-5733
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:507-825-5811
Practice Address - Fax:507-825-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327538282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0120250Medicaid
IA0919415Medicaid
MN300622OtherUCARE
MI521247200Medicaid
SD5520250Medicaid
1124044881OtherNPI
MN430081OtherDAKOTA HEALTH PLAN
CO62601849Medicaid
MN1017039OtherPREFERRED ONE
ND01021Medicaid
MN236064OtherFEDERATED MUTUAL /AM PPO
MN8017039OtherPERFERREDONE ADM SERV
MN21041OtherHEALTH PARTNERS
MN827121632OtherPRIMEWEST
1447300587OtherNPI
1598751240OtherNPI
MN1811HPIOtherBCBS
MN5025427OtherMEDICA
MN827121632OtherPRIMEWEST
MN430081OtherDAKOTA HEALTH PLAN
MNC06075Medicare UPIN