Provider Demographics
NPI:1538225065
Name:POLK COUNTY AUDITOR
Entity type:Organization
Organization Name:POLK COUNTY AUDITOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-281-3385
Mailing Address - Street 1:721 S MINNESOTA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-1800
Mailing Address - Country:US
Mailing Address - Phone:218-281-3385
Mailing Address - Fax:218-281-7376
Practice Address - Street 1:816 MARIN AVE
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-2148
Practice Address - Country:US
Practice Address - Phone:218-281-3385
Practice Address - Fax:218-281-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251K00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5900265OtherMEDICA PROVIDER NUMBER
MN029053000Medicaid
MN169865OtherUCARE PROVIDER NUMBER
MN8G544POOtherBLUE CROSS PROVIDER #
MN050615001OtherMHP PROVIDER NUMBER
MN050615001OtherMHP PROVIDER NUMBER