1831192764 NPI number — COUNTY OF KOOCHICHING

Table of content: (NPI 1831192764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831192764 NPI number — COUNTY OF KOOCHICHING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF KOOCHICHING
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:
KOOCHICHING COUNTY HEALTH DEPARTMENT
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:
1831192764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 5TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INTERNATIONAL FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56649-2243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-283-7070
Provider Business Mailing Address Fax Number:
218-283-7050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INTERNATIONAL FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56649-2243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-283-7070
Provider Business Practice Location Address Fax Number:
218-283-7050
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LAFRANCE
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
218-283-7000

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  251E00000X , 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: 127757 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 700855400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8264KO . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 83-00013 . This is a "MEDICA CHOICE PROV NO." identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 59-00164 . This is a "MEDICA CHOICE PROVIDER NO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 06G63KO . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 730000121 . This is a "MEDICARE PART B" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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