Provider Demographics
NPI:1750378295
Name:BRAINERD LAKES SURGERY CENTER L L C
Entity type:Organization
Organization Name:BRAINERD LAKES SURGERY CENTER L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWENDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-822-2415
Mailing Address - Street 1:13114 ISLE DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8330
Mailing Address - Country:US
Mailing Address - Phone:218-822-2400
Mailing Address - Fax:218-822-2401
Practice Address - Street 1:13114 ISLE DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8330
Practice Address - Country:US
Practice Address - Phone:218-822-2400
Practice Address - Fax:218-822-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328113261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0L00BROtherBCBS
MN2314785OtherAMERICAS PPO ARAZ
MN6800051OtherSELECT CARE
MN105730OtherHEALTHPARTNERS
MN181112OtherUCARE
MN1043422OtherPREFERRED ONE
MNP00205406OtherPALMETTO GBA
MN6800051OtherMEDICA
MN201937000Medicaid
MNP00205406OtherPALMETTO GBA
MN490000047Medicare ID - Type Unspecified
MN0L00BROtherBCBS