=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396818175
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF SIBLEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 12/31/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 8TH STREET
-----------------------------------------------------
City | GAYLORD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-237-4035
-----------------------------------------------------
Fax | 507-237-4031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 237
-----------------------------------------------------
City | GAYLORD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55334-0237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-237-4035
-----------------------------------------------------
Fax | 507-237-4031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. KLEA MS RETTMANN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-237-4000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP0905X
-----------------------------------------------------
Taxonomy Name | State or Local Public Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------