1689677478 NPI number — COUNTY OF DOUGLAS

Table of content: (NPI 1689677478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689677478 NPI number — COUNTY OF DOUGLAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF DOUGLAS
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:
1689677478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 ELM ST
Provider Second Line Business Mailing Address:
STE 1200
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56308-1760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-763-6018
Provider Business Mailing Address Fax Number:
320-763-4127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 ELM ST
Provider Second Line Business Practice Location Address:
STE 1200
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56308-1760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-763-6018
Provider Business Practice Location Address Fax Number:
320-763-4127
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TUBBS
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
320-763-6018

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: 326907 , 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: 31359 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 03072603200 . This is a "PRIMEWEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 83-02316 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8276DO . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1006413 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 59-00162 . This is a "MEDICA HOME CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 76523DO . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 122917 . This is a "UCARE MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 758353200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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