1215906680 NPI number — CITY OF SLEEPY EYE

Table of content: (NPI 1215906680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215906680 NPI number — CITY OF SLEEPY EYE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SLEEPY EYE
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:
1215906680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 4TH AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLEEPY EYE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56085-1109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-795-3691
Provider Business Mailing Address Fax Number:
507-794-5950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 4TH AVENUE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLEEPY EYE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56085-0323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-794-3691
Provider Business Practice Location Address Fax Number:
507-794-5950
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SELLHEIM
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
CEO/ADMINISTRATOR
Authorized Official Telephone Number:
507-794-8440

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , 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: 0186394 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 487308400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ9359 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01013532 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400031 . This is a "UCARE RHC PHYSICIAN FEES" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 106628 . This is a "UCARE SLEEPY EYE CLINIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112501 . This is a "UCARE MORGAN CLINIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 308014900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7S90SL . This is a "BCBS-RHC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 43202SL . This is a "BCBS PROF FEES & MORGAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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