Provider Demographics
NPI:1023001260
Name:OTTER TAIL COUNTY AUDITOR
Entity Type:Organization
Organization Name:OTTER TAIL COUNTY AUDITOR
Other - Org Name:OTTER TAIL COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-998-8338
Mailing Address - Street 1:560 W FIR AVE
Mailing Address - Street 2:GOVERNMENT SERVICES CENTER
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1364
Mailing Address - Country:US
Mailing Address - Phone:218-998-8320
Mailing Address - Fax:218-998-8352
Practice Address - Street 1:560 W FIR AVE
Practice Address - Street 2:GOVERNMENT SERVICES CENTER
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1364
Practice Address - Country:US
Practice Address - Phone:218-998-8320
Practice Address - Fax:218-998-8352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN325747251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN518853900Medicaid
MN8226OTOtherBLUE CROSS - HOME VISITS
MN06G53OTOtherBLUE CROSS CLINICAL VISIT
MN01035279OtherPREFERRED ONE - CLINICAL
MN124764OtherUCARE
MN8300086OtherMEDICA - CLINICAL VISITS
MN5900190OtherMEDICA HOME VISITS
MN01016702OtherPREFERRED ONE HOME VISITS