1316942774 NPI number — LE SUEUR COUNTY

Table of content: (NPI 1316942774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316942774 NPI number — LE SUEUR COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LE SUEUR COUNTY
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:
1316942774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
88 S PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LE CENTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56057-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-357-8246
Provider Business Mailing Address Fax Number:
507-357-4223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 S PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LE CENTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56057-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-357-8246
Provider Business Practice Location Address Fax Number:
507-357-4223
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KIRBY
Authorized Official First Name:
MEGAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PUBLIC HEALTH
Authorized Official Telephone Number:
507-357-8247

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X , with the licence number: 328150 , 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: 84639 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 115945 . This is a "UCARE PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 118753800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8204 LE . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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