1255436721 NPI number — COUNTY OF AITKIN

Table of content: (NPI 1255436721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255436721 NPI number — COUNTY OF AITKIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF AITKIN
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:
1255436721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 1ST ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AITKIN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56431-1260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-927-7200
Provider Business Mailing Address Fax Number:
218-927-7461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 1ST ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AITKIN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56431-1260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-927-7200
Provider Business Practice Location Address Fax Number:
218-927-7461
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENNETT
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
218-927-7200

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: 7C16CAI . This is a "BC/BS MULTI SPECIALITY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8460714 . This is a "MEDICA RULE 25" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 52F92AI . This is a "BC/BS RULE 25" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 07Z44AI . This is a "BC/BS PMAP MILEAGE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0Z00AI . This is a "BC/BS DETOX" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 277553100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 035H7AI . This is a "BC/BS MASS IMMUNIZATION" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5900201 . This is a "MEDICA HOME VISIT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 683P3AI . This is a "BC/BS MH-TCM" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 125245 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 38P89AI . This is a "BC/BS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 130955 . This is a "UCARE OTHER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8300100 . This is a "MEDICA IMMUNIZATIONS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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