1194945071 NPI number — CITY OF BUFFALO LAKE

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 1194945071 NPI number — CITY OF BUFFALO LAKE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BUFFALO LAKE
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:
1194945071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO LAKE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55314-0094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-833-2272
Provider Business Mailing Address Fax Number:
320-833-2344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55314-1036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-833-2272
Provider Business Practice Location Address Fax Number:
320-833-2344
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
CITY CLERK
Authorized Official Telephone Number:
320-833-2272

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0039 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8180514 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 040624003 . This is a "PRIME WEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 591067600 . This is a "HARTFORD INSURANCE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 47046BU . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: M491067600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 591067600 . This is a "SENTRY CLAIMS SERVICES" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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