Provider Demographics
NPI:1871651646
Name:NORTHERN PINES MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTHERN PINES MEDICAL CENTER
Other - Org Name:WHITE COMMUNITY HOSPITAL CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:ACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-229-2211
Mailing Address - Street 1:5211 HWY 110
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MN
Mailing Address - Zip Code:55705
Mailing Address - Country:US
Mailing Address - Phone:218-229-2211
Mailing Address - Fax:218-229-2042
Practice Address - Street 1:5211 HWY 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MN
Practice Address - Zip Code:55705
Practice Address - Country:US
Practice Address - Phone:218-229-2211
Practice Address - Fax:218-229-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN173347800Medicaid
MN173347800Medicaid