1093828766 NPI number — OKLEE ECONOMIC DEVELOPMENT

Table of content: (NPI 1093828766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093828766 NPI number — OKLEE ECONOMIC DEVELOPMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OKLEE ECONOMIC DEVELOPMENT
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:
6
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:
1093828766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 186
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLEE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56742-9998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-234-6090
Provider Business Mailing Address Fax Number:
218-520-0906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLEE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56742-5674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-234-6090
Provider Business Practice Location Address Fax Number:
218-520-0906
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CROSS
Authorized Official First Name:
DEREK
Authorized Official Middle Name:
Authorized Official Title or Position:
CITY CLERK
Authorized Official Telephone Number:
218-796-5183

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 361567700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 63597OK . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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