Provider Demographics
NPI:1831192764
Name:COUNTY OF KOOCHICHING
Entity type:Organization
Organization Name:COUNTY OF KOOCHICHING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-283-7000
Mailing Address - Street 1:1000 5TH ST
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2243
Mailing Address - Country:US
Mailing Address - Phone:218-283-7070
Mailing Address - Fax:218-283-7050
Practice Address - Street 1:1000 5TH ST
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2243
Practice Address - Country:US
Practice Address - Phone:218-283-7070
Practice Address - Fax:218-283-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN730000121OtherMEDICARE PART B
MN127757OtherUCARE
MN8264KOOtherBCBS PROVIDER NUMBER
MN83-00013OtherMEDICA CHOICE PROV NO.
MN06G63KOOtherBCBS PROVIDER NUMBER
MN700855400Medicaid
MN59-00164OtherMEDICA CHOICE PROVIDER NO