1093700841 NPI number — POPE COUNTY PUBLIC HEALTH NURSING SERVICE

Table of content: (NPI 1093700841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093700841 NPI number — POPE COUNTY PUBLIC HEALTH NURSING SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POPE COUNTY PUBLIC HEALTH NURSING SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093700841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 MINNESOTA AVE E
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GLENWOOD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56334-1629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-634-5720
Provider Business Mailing Address Fax Number:
320-634-0159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 MINNESOTA AVE E
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GLENWOOD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56334-1629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-634-5720
Provider Business Practice Location Address Fax Number:
320-634-0159
Provider Enumeration Date:
09/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BRAATEN
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
320-634-5720

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8270PO . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 829421017248 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 83000089 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 126381 . This is a "U CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8G547PO . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03072603600 . This is a "PRIMEWEST" identifier . This identifiers is of the category "OTHER".




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