Organization
COUNTY OF ITASCA
Active
Organization
COUNTY OF ITASCA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WENDY MCINTYRE (ACCOUNTING TECHNICIAN)
(218) 327-6162
Entity
Organization
Contact information
Practice address
1209 SE 2ND AVE, GRAND RAPIDS, MN 55744-3982
(218) 327-2941
(218) 327-5547
Mailing address
1209 SE 2ND AVE, GRAND RAPIDS, MN 55744-3982
(218) 327-2941
(218) 327-5547
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
241569
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54029IT
MNCARE BLUE PLUS
MN
01
—
730000011
MEDICARE PTAN
MN
05
—
768553000
—
MN
Enumeration date
02/27/2007
Last updated
09/04/2013
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