1073635249 NPI number — COUNTY OF PINE

Table of content: (NPI 1073635249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073635249 NPI number — COUNTY OF PINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF PINE
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:
PINE COUNTY PUBLIC HEALTH NURSING
Provider Other Organization Name Type Code:
5
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:
1073635249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 ORIOLE ST E
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
SANDSTONE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55072-5134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-216-4100
Provider Business Mailing Address Fax Number:
320-216-4101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1610 HIGHWAY 23 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDSTONE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55072-5009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-216-4140
Provider Business Practice Location Address Fax Number:
320-216-4101
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARON
Authorized Official First Name:
RUSS
Authorized Official Middle Name:
Authorized Official Title or Position:
FISCAL SUPERVISER
Authorized Official Telephone Number:
320-216-4108

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , 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)





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