Provider Demographics
NPI:1679576912
Name:COUNTY OF WADENA
Entity type:Organization
Organization Name:COUNTY OF WADENA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEPPERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHN, MS
Authorized Official - Phone:218-631-7629
Mailing Address - Street 1:22 DAYTON AVE SE
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1526
Mailing Address - Country:US
Mailing Address - Phone:218-631-7629
Mailing Address - Fax:218-631-7632
Practice Address - Street 1:22 DAYTON AVE SE
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1526
Practice Address - Country:US
Practice Address - Phone:218-631-7629
Practice Address - Fax:218-631-7632
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF WADENA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-31
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN010256300Medicaid
MN730000093Medicare PIN
MN010256300Medicaid