Provider Demographics
NPI:1821084658
Name:PIPESTONE COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:PIPESTONE COUNTY MEDICAL CENTER
Other - Org Name:PIPESTONE COUNTY HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
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:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN326877251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN521247200Medicaid
MN5025427OtherMEDICA
MN8017039OtherPREFERRED ONE ADM SERV
MN0919415OtherMEDICAID OF IOWA
MN1071520Medicaid
MN1811APIOtherBCBS
MN430081OtherDAKOTA HEALTH PLAN
MN827121632OtherPRIMEWEST
MN1017039OtherPREFERRED ONE
MN21041OtherHEALTH PARTNERS
MN236064OtherFEDERATED MUTUAL AM PPO
MN521247200Medicaid
MN1071520Medicaid