Provider Demographics
NPI:1497722318
Name:COUNTY OF FILLMORE
Entity Type:Organization
Organization Name:COUNTY OF FILLMORE
Other - Org Name:FILLMORE COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DON
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHN
Authorized Official - Phone:507-765-2647
Mailing Address - Street 1:902 HOUSTON ST NW
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:MN
Mailing Address - Zip Code:55965-1094
Mailing Address - Country:US
Mailing Address - Phone:507-765-3898
Mailing Address - Fax:507-765-2139
Practice Address - Street 1:902 HOUSTON ST NW
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:MN
Practice Address - Zip Code:55965
Practice Address - Country:US
Practice Address - Phone:507-765-3898
Practice Address - Fax:507-765-2139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328391251E00000X
251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN928353600Medicaid
MN247010Medicare ID - Type UnspecifiedPROVIDER NUMBER