1679584205 NPI number — CITY OF LAKE CRYSTAL

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 1679584205 NPI number — CITY OF LAKE CRYSTAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF LAKE CRYSTAL
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:
1679584205
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:
100 EAST ROBINSON STREET
Provider Second Line Business Mailing Address:
P.O. BOX 86
Provider Business Mailing Address City Name:
LAKE CRYSTAL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56055-0086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-726-2538
Provider Business Mailing Address Fax Number:
507-726-2265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 S HUNT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CRYSTAL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56055-0086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-726-2538
Provider Business Practice Location Address Fax Number:
507-726-2265
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAUGE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CITY ADMINISTRATOR
Authorized Official Telephone Number:
507-726-2538

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0127 , 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)





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