1205833407 NPI number — CASS COUNTY MN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205833407 NPI number — CASS COUNTY MN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASS COUNTY MN
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:
CASS 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:
1205833407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 519
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALKER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56484-0519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-547-1340
Provider Business Mailing Address Fax Number:
218-547-1448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALKER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56484-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-547-1340
Provider Business Practice Location Address Fax Number:
218-547-1448
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PIPRUDE
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
218-547-6863

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 017753900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8232CA . This is a "BCBS INSTITUTIONAL NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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