Provider Demographics
NPI:1104827500
Name:MILLE LACS COUNTY PUBLIC HEALTH NURSING SERVICE
Entity type:Organization
Organization Name:MILLE LACS COUNTY PUBLIC HEALTH NURSING SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MLC CVS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-983-9208
Mailing Address - Street 1:525 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:MILACA
Mailing Address - State:MN
Mailing Address - Zip Code:56353-1303
Mailing Address - Country:US
Mailing Address - Phone:320-983-8318
Mailing Address - Fax:320-983-8353
Practice Address - Street 1:620 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353-1777
Practice Address - Country:US
Practice Address - Phone:320-983-8318
Practice Address - Fax:320-983-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN548753600251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN45316OtherHEALTH PARTNERS
MN8302313OtherMEDICA
MN8251MIOtherBLUE CROSS BLUE SHIELD
MN07G89MIOtherBLUE PLUS
MN548753600Medicaid
MN125056OtherUCARE
MN07G89MIOtherBLUE PLUS