Provider Demographics
NPI:1417176660
Name:COUNTY OF MOWER
Entity Type:Organization
Organization Name:COUNTY OF MOWER
Other - Org Name:PUBLIC HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMMUNITY HEALTH SERVICES DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHN
Authorized Official - Phone:507-437-9770
Mailing Address - Street 1:1301 18TH AVE NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-1888
Mailing Address - Country:US
Mailing Address - Phone:507-437-9770
Mailing Address - Fax:507-434-2695
Practice Address - Street 1:1301 18TH AVE NW
Practice Address - Street 2:SUITE A
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1888
Practice Address - Country:US
Practice Address - Phone:507-437-9770
Practice Address - Fax:507-434-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN176845300314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN176485300OtherMINNESOTA HEALTH CARE PRO