=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215906680
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF SLEEPY EYE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2006
-----------------------------------------------------
Last Update Date | 09/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 4TH AVENUE NW
-----------------------------------------------------
City | SLEEPY EYE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56085-0323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-794-3691
-----------------------------------------------------
Fax | 507-794-5950
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 4TH AVE NW
-----------------------------------------------------
City | SLEEPY EYE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56085-1109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-795-3691
-----------------------------------------------------
Fax | 507-794-5950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ADMINISTRATOR
-----------------------------------------------------
Name | KEVIN ROBERT SELLHEIM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-794-8440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------