1124190640 NPI number — COUNTY OF ANOKA

Table of content: (NPI 1124190640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124190640 NPI number — COUNTY OF ANOKA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF ANOKA
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:
1124190640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 THIRD AVENUE
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
ANOKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-324-4200
Provider Business Mailing Address Fax Number:
763-324-1033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 THIRD AVENUE
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
ANOKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-324-4200
Provider Business Practice Location Address Fax Number:
763-324-1033
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUBBARD
Authorized Official First Name:
JONELLE
Authorized Official Middle Name:
KATHERINE
Authorized Official Title or Position:
COMMUNITY HEALTH DIRECTOR
Authorized Official Telephone Number:
763-324-4200

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: 3095 . This is a "MHP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 54P50AN . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2837 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3788577 . This is a "AETNA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 106850 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8300102 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 139353700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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