Organization
GLENCOE REGIONAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON D. BRABAND (PRESIDENT & CEO)
(320) 864-7752
Entity
Organization
Contact information
Practice address
1805 HENNEPIN AVE. NO., GLENCOE, MN 55336-1416
(320) 864-3121
(320) 864-7880
Mailing address
1805 HENNEPIN AVE. NO., GLENCOE, MN 55336-1416
(320) 864-3121
(320) 864-7880
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
213E00000X
Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1308930001
MEDICARE
MN
01
—
241355
MEDICARE
MN
01
—
245263
MEDICARE
MN
01
—
24Z355
MEDICARE
MN
05
—
620977700
—
MN
05
—
909545400
—
MN
Enumeration date
12/01/2008
Last updated
12/01/2008
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