Provider Demographics
NPI:1689677478
Name:COUNTY OF DOUGLAS
Entity Type:Organization
Organization Name:COUNTY OF DOUGLAS
Other - Org Name:DOUGLAS COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHN
Authorized Official - Phone:320-763-6018
Mailing Address - Street 1:725 ELM ST
Mailing Address - Street 2:STE 1200
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-1760
Mailing Address - Country:US
Mailing Address - Phone:320-763-6018
Mailing Address - Fax:320-763-4127
Practice Address - Street 1:725 ELM ST
Practice Address - Street 2:STE 1200
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1760
Practice Address - Country:US
Practice Address - Phone:320-763-6018
Practice Address - Fax:320-763-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251B00000X, 251K00000X
MN326907251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN31359OtherHEALTH PARTNERS
MN03072603200OtherPRIMEWEST
MN83-02316OtherMEDICA
MN8276DOOtherBLUE CROSS/BLUE SHIELD
MN1006413OtherPREFERRED ONE
MN59-00162OtherMEDICA HOME CARE
MN76523DOOtherBLUE CROSS/BLUE SHIELD
MN122917OtherUCARE MINNESOTA
MN758353200Medicaid
MN8276DOOtherBLUE CROSS/BLUE SHIELD
MN76523DOOtherBLUE CROSS/BLUE SHIELD