Provider Demographics
NPI:1083779169
Name:NOBLES-ROCK COMMUNITY HEALTH SERVICES
Entity Type:Organization
Organization Name:NOBLES-ROCK COMMUNITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:507-372-8256
Mailing Address - Street 1:315 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2315
Mailing Address - Country:US
Mailing Address - Phone:507-372-8256
Mailing Address - Fax:
Practice Address - Street 1:315 10TH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2315
Practice Address - Country:US
Practice Address - Phone:507-372-8256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3486464251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7Y30NOOtherBLUE CROSS & BLUE SHIELD
MN62B70NOOtherBLUE CROSS & BLUE SHIELD
MN7Y30NOOtherBLUE CROSS & BLUE SHIELD
MN116884Medicare UPIN