MEDICARE: DAKOTA COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316266521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAKOTA COUNTY

Provider Business Mailing Address
First Line	:	1590 HIGHWAY 55
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-2343
Country	:	US
Telephone Number	:	651-438-4508
Fax Number	:	651-438-4603

Provider Business Practice Location Address
First Line	:	1 MENDOTA RD W STE 300
Second Line	:
City	:	WEST ST PAUL
State	:	MN
Zip	:	55118-4770
Country	:	US
Telephone Number	:	651-438-4508
Fax Number	:	651-438-4603

Authorized Official
Title or Position	:	SENIOR ACCOUNTING MANAGER
Name	:	MRS. GINA BIRK
Credential	:
Telephone Number	:	651-438-4508

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	05/27/2010

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Directions to “DAKOTA COUNTY ” Practice Location

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