Provider Demographics
NPI:1073635249
Name:COUNTY OF PINE
Entity Type:Organization
Organization Name:COUNTY OF PINE
Other - Org Name:PINE COUNTY PUBLIC HEALTH NURSING
Other - Org Type:Other Name
Authorized Official - Title/Position:FISCAL SUPERVISER
Authorized Official - Prefix:
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-216-4108
Mailing Address - Street 1:130 ORIOLE ST E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANDSTONE
Mailing Address - State:MN
Mailing Address - Zip Code:55072-5134
Mailing Address - Country:US
Mailing Address - Phone:320-216-4100
Mailing Address - Fax:320-216-4101
Practice Address - Street 1:1610 HIGHWAY 23 N
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-5009
Practice Address - Country:US
Practice Address - Phone:320-216-4140
Practice Address - Fax:320-216-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN908853900Medicare ID - Type UnspecifiedPUBLIC HEALTH AGENCY