1609869726 NPI number — GREATER MINNESOTA FAMILY SERVICES

Table of content: (NPI 1609869726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609869726 NPI number — GREATER MINNESOTA FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER MINNESOTA FAMILY SERVICES
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:
1609869726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2320 HIGHWAY 12 E STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLMAR
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56201-5811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-214-9692
Provider Business Mailing Address Fax Number:
320-214-9924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2320 HIGHWAY 12 E STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLMAR
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56201-5811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-214-9692
Provider Business Practice Location Address Fax Number:
320-214-9924
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DUBIE
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
320-214-9692

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  810871-2-MHC , 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: 030726018 . This is a "PRIMEWEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 60144 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 915319500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05Q36GR . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 005392900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 241016800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62-54676 . This is a "MEDICA/UBH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 122230 . This is a "BHP/UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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