Healthcare Provider Details

I. General information

NPI: 1336153600
Provider Name (Legal Business Name): COUNTY OF WILKIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 5TH ST S
BRECKENRIDGE MN
56520-1918
US

IV. Provider business mailing address

PO BOX 127
BRECKENRIDGE MN
56520
US

V. Phone/Fax

Practice location:
  • Phone: 218-643-7122
  • Fax: 218-643-7166
Mailing address:
  • Phone: 218-643-7122
  • Fax: 218-643-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEBRA A JACOBS
Title or Position: DIRECTOR
Credential: PHN
Phone: 218-643-7122