1972550986 NPI number — TOWN OF LAND O LAKES

Table of content: (NPI 1972550986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972550986 NPI number — TOWN OF LAND O LAKES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF LAND O LAKES
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:
1972550986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 660
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAND O LAKES
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54540-0660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4337 HWY B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAND O' LAKES
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-547-3255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAAKE
Authorized Official First Name:
SIG
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERVISOR
Authorized Official Telephone Number:
715-547-3255

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000088714 . This is a "ADVOCARE MCHMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41342800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: WI0100 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 323265400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4591575 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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