1023001260 NPI number — OTTER TAIL COUNTY AUDITOR

Table of content: (NPI 1023001260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023001260 NPI number — OTTER TAIL COUNTY AUDITOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OTTER TAIL COUNTY AUDITOR
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:
OTTER TAIL COUNTY PUBLIC HEALTH
Provider Other Organization Name Type Code:
3
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:
1023001260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 W FIR AVE
Provider Second Line Business Mailing Address:
GOVERNMENT SERVICES CENTER
Provider Business Mailing Address City Name:
FERGUS FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56537-1364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-998-8320
Provider Business Mailing Address Fax Number:
218-998-8352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 W FIR AVE
Provider Second Line Business Practice Location Address:
GOVERNMENT SERVICES CENTER
Provider Business Practice Location Address City Name:
FERGUS FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56537-1364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-998-8320
Provider Business Practice Location Address Fax Number:
218-998-8352
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LIEN
Authorized Official First Name:
JODY
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
218-998-8338

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  325747 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 518853900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8226OT . This is a "BLUE CROSS - HOME VISITS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 06G53OT . This is a "BLUE CROSS CLINICAL VISIT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01035279 . This is a "PREFERRED ONE - CLINICAL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 124764 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8300086 . This is a "MEDICA - CLINICAL VISITS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5900190 . This is a "MEDICA HOME VISITS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01016702 . This is a "PREFERRED ONE HOME VISITS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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