Healthcare Provider Details

I. General information

NPI: 1346374550
Provider Name (Legal Business Name): COUNTRYSIDE PUBLIC HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 13TH ST S
BENSON MN
56215-1856
US

IV. Provider business mailing address

201 13TH ST S
BENSON MN
56215-1856
US

V. Phone/Fax

Practice location:
  • Phone: 320-843-4546
  • Fax: 320-843-4094
Mailing address:
  • Phone: 320-843-4546
  • Fax: 320-843-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateMN

VIII. Authorized Official

Name: ELIZABETH AUCH
Title or Position: ADMINISTRATOR
Credential: PHN
Phone: 320-843-4546