1053492330 NPI number — COUNTY OF CHISAGO

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 1053492330 NPI number — COUNTY OF CHISAGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF CHISAGO
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:
1053492330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
313 N MAIN ST
Provider Second Line Business Mailing Address:
ROOM 240
Provider Business Mailing Address City Name:
CENTER CITY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-213-5639
Provider Business Mailing Address Fax Number:
651-213-5685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6133 402ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BRANCH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55056-6097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-213-5231
Provider Business Practice Location Address Fax Number:
651-213-5401
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRIGGS
Authorized Official First Name:
JILL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR OF PUBLIC HEALTH
Authorized Official Telephone Number:
651-213-5231

Provider Taxonomy Codes

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

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

  • Identifier: 599722400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120907 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8300059 . This is a "MEDICA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 2042UDE . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5248 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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