1538225065 NPI number — POLK COUNTY AUDITOR

Table of content: (NPI 1538225065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538225065 NPI number — POLK COUNTY AUDITOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POLK COUNTY AUDITOR
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:
1538225065
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
721 S MINNESOTA ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
CROOKSTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56716-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-281-3385
Provider Business Mailing Address Fax Number:
218-281-7376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
816 MARIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROOKSTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56716-2148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-281-3385
Provider Business Practice Location Address Fax Number:
218-281-7376
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REESE
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
218-281-3385

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  251K00000X , 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: 5900265 . This is a "MEDICA PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 029053000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 169865 . This is a "UCARE PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8G544PO . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 050615001 . This is a "MHP PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com