Provider Demographics
NPI:1679565287
Name:COUNTY OF MURRAY
Entity type:Organization
Organization Name:COUNTY OF MURRAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR CEO
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-836-1277
Mailing Address - Street 1:2040 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:507-836-6153
Mailing Address - Fax:507-836-8787
Practice Address - Street 1:2040 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:SLAYTON
Practice Address - State:MN
Practice Address - Zip Code:56172-1017
Practice Address - Country:US
Practice Address - Phone:507-836-6153
Practice Address - Fax:507-836-8787
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MURRAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN431820000Medicaid
MNC02838Medicare ID - Type Unspecified
MN243417Medicare Oscar/Certification