1851497309 NPI number — COUNTY OF ISANTI

Table of content: (NPI 1851497309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851497309 NPI number — COUNTY OF ISANTI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF ISANTI
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:
1851497309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 18TH AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-689-4071
Provider Business Mailing Address Fax Number:
763-689-8293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 18TH AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-689-4071
Provider Business Practice Location Address Fax Number:
763-689-8293
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUTTACAVOLI
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
GLENN
Authorized Official Title or Position:
CHS ADMINISTRATOR/ DIRECTOR
Authorized Official Telephone Number:
763-689-8284

Provider Taxonomy Codes

  • Taxonomy code: 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: 1025957 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8220IS . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 116467 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 399853300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8G633IF . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8300061 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8G633IS . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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