1710083928 NPI number — COUNTY OF SWIFT IND SCHOOL DISTRICT 777

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 1710083928 NPI number — COUNTY OF SWIFT IND SCHOOL DISTRICT 777

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SWIFT IND SCHOOL DISTRICT 777
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:
1710083928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 N 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEVIDEO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56265-1406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-269-9243
Provider Business Mailing Address Fax Number:
320-269-7132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 MONTANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENSON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56215-1246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-843-2710
Provider Business Practice Location Address Fax Number:
320-843-2262
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RITTER
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
Authorized Official Title or Position:
3RD PARTY BILLING ADMIN.
Authorized Official Telephone Number:
320-269-9243

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 682680600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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