Organization
BROADWAY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLENE A MYREN (ASSISTANT ADMINISTRATOR)
(320) 762-6841
Entity
Organization
Contact information
Practice address
1527 BROADWAY ST, ALEXANDRIA, MN 56308-2537
(320) 762-0399
(320) 762-6847
Mailing address
1527 BROADWAY ST, ALEXANDRIA, MN 56308-2537
(320) 762-0399
(320) 762-6847
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
590
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31T03BR
BCBS
MN
05
—
365838400
—
MN
Enumeration date
01/30/2006
Last updated
02/08/2012
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