Provider Demographics
NPI:1043281876
Name:COUNTY OF BELTRAMI
Entity type:Organization
Organization Name:COUNTY OF BELTRAMI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:BORGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:218-333-8116
Mailing Address - Street 1:616 AMERICA AVENUE NW SUITE 340
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3873
Mailing Address - Country:US
Mailing Address - Phone:218-333-8140
Mailing Address - Fax:218-333-8360
Practice Address - Street 1:616 AMERICA AVENUE NW SUITE 340
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3873
Practice Address - Country:US
Practice Address - Phone:218-333-8100
Practice Address - Fax:218-333-8360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN306J5BEOtherBLUE CROSS BLUE SHIELD
MN8231BEOtherBLUE CROSS BLUE SHIELD
MN8300068OtherMEDICA
MN567553700Medicaid
MN247057Medicare PIN