1396818175 NPI number — COUNTY OF SIBLEY

Table of content: (NPI 1396818175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396818175 NPI number — COUNTY OF SIBLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SIBLEY
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:
1396818175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 237
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAYLORD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55334-0237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-237-4035
Provider Business Mailing Address Fax Number:
507-237-4031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 8TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAYLORD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-237-4035
Provider Business Practice Location Address Fax Number:
507-237-4031
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RETTMANN
Authorized Official First Name:
KLEA
Authorized Official Middle Name:
MS
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
507-237-4000

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1022762 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1396818175 . This is a "BLUE CROSS AND BLUE SHIELD OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 110755100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115485 . This is a "SOUTH COUNTRY HEALTH ALLI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8300096 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".




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