Provider Demographics
NPI:1578550190
Name:MCLEOD COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:MCLEOD COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-864-3185
Mailing Address - Street 1:1805 FORD AVE N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLENCOE
Mailing Address - State:MN
Mailing Address - Zip Code:55336-1363
Mailing Address - Country:US
Mailing Address - Phone:320-864-3185
Mailing Address - Fax:320-864-1484
Practice Address - Street 1:1805 FORD AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336-1363
Practice Address - Country:US
Practice Address - Phone:320-864-3185
Practice Address - Fax:320-864-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328290251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59-00188OtherMEDICA
MN27257OtherHEALTH PARTNERS
MN8G775MCOtherBLUE PLUS
MN1013475OtherPREFERRED ONE
MN03072603400OtherPRIME WEST
MN8223MCOtherBCBS
ME247067Medicare ID - Type UnspecifiedMEDICARE