Provider Demographics
NPI:1578735833
Name:COUNTY OF MURRAY
Entity Type:Organization
Organization Name:COUNTY OF MURRAY
Other - Org Name:MURRAY COUNTY CLINIC FULDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-836-1274
Mailing Address - Street 1:2042 JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:SLAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:56172-1017
Mailing Address - Country:US
Mailing Address - Phone:507-836-1274
Mailing Address - Fax:507-836-1275
Practice Address - Street 1:119 N ST PAUL AVE
Practice Address - Street 2:
Practice Address - City:FULDA
Practice Address - State:MN
Practice Address - Zip Code:56131-1156
Practice Address - Country:US
Practice Address - Phone:507-836-1274
Practice Address - Fax:507-836-1275
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MURRAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health