Provider Demographics
NPI:1346300704
Name:ROLETTE COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:ROLETTE COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-477-5646
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-0726
Mailing Address - Country:US
Mailing Address - Phone:701-477-5646
Mailing Address - Fax:701-477-9578
Practice Address - Street 1:211 1ST AVE NE
Practice Address - Street 2:BOX 726
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367-0726
Practice Address - Country:US
Practice Address - Phone:701-477-5646
Practice Address - Fax:701-477-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND52525Medicaid
ND71118Medicare ID - Type Unspecified