Provider Demographics
NPI:1659447555
Name:BENTON COUNTY
Entity Type:Organization
Organization Name:BENTON COUNTY
Other - Org Name:BENTON COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HUMAN SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-968-5088
Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329-0740
Mailing Address - Country:US
Mailing Address - Phone:320-968-5087
Mailing Address - Fax:320-968-5330
Practice Address - Street 1:531 DEWEY ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329-8413
Practice Address - Country:US
Practice Address - Phone:320-968-5087
Practice Address - Fax:320-968-5330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN83-00075OtherMECIA
MN111725OtherUCARE