Provider Demographics
NPI:1336153600
Name:COUNTY OF WILKIN
Entity type:Organization
Organization Name:COUNTY OF WILKIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHN
Authorized Official - Phone:218-643-7122
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520
Mailing Address - Country:US
Mailing Address - Phone:218-643-7122
Mailing Address - Fax:218-643-7166
Practice Address - Street 1:300 5TH ST S
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1918
Practice Address - Country:US
Practice Address - Phone:218-643-7122
Practice Address - Fax:218-643-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164868501Medicaid
MN8260WIOtherBCBS OF MN
ND54484Medicaid
MN659253800Medicaid
MN8300065OtherMEDICA
MN8G500WIOtherBLUE PLUS
TX164868501Medicaid