1578550190 NPI number — MCLEOD COUNTY PUBLIC HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578550190 NPI number — MCLEOD COUNTY PUBLIC HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCLEOD COUNTY PUBLIC HEALTH
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:
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:
1578550190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 FORD AVE N
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
GLENCOE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55336-1363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-864-3185
Provider Business Mailing Address Fax Number:
320-864-1484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1805 FORD AVE N
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
GLENCOE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55336-1363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-864-3185
Provider Business Practice Location Address Fax Number:
320-864-1484
Provider Enumeration Date:
09/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FELLING
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
AGENCY ADMINISTRATOR
Authorized Official Telephone Number:
320-864-3185

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  328290 , 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: 59-00188 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 27257 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8G775MC . This is a "BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1013475 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 03072603400 . This is a "PRIME WEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8223MC . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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