1104827500 NPI number — MILLE LACS COUNTY PUBLIC HEALTH NURSING SERVICE

Table of content: (NPI 1104827500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104827500 NPI number — MILLE LACS COUNTY PUBLIC HEALTH NURSING SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLE LACS COUNTY PUBLIC HEALTH NURSING SERVICE
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:
1104827500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 2ND ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILACA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56353-1303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-983-8318
Provider Business Mailing Address Fax Number:
320-983-8353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 CENTRAL AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILACA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56353-1777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-983-8318
Provider Business Practice Location Address Fax Number:
320-983-8353
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CROOK
Authorized Official First Name:
BETH
Authorized Official Middle Name:
Authorized Official Title or Position:
MLC CVS DIRECTOR
Authorized Official Telephone Number:
320-983-9208

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  548753600 , 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: 45316 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8302313 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8251MI . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 07G89MI . This is a "BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 548753600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125056 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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