Organization
POLK COUNTY AUDITOR
Active
Other names
Polk County Public Health
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH REESE (DIRECTOR)
(218) 281-3385
Entity
Organization
Contact information
Practice address
816 MARIN AVE, CROOKSTON, MN 56716-2148
(218) 281-3385
(218) 281-7376
Mailing address
721 S MINNESOTA ST, SUITE 1, CROOKSTON, MN 56716-1800
(218) 281-3385
(218) 281-7376
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
251K00000X
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029053000
—
MN
01
—
050615001
MHP PROVIDER NUMBER
MN
01
—
169865
UCARE PROVIDER NUMBER
MN
01
—
5900265
MEDICA PROVIDER NUMBER
MN
01
—
8G544PO
BLUE CROSS PROVIDER #
MN
Enumeration date
12/29/2006
Last updated
12/19/2019
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