MEDICARE: COUNTY OF KOOCHICHING

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	251K00000X	Public Health or Welfare Agency	251E00000X	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	730000121	OTHER	MN	MEDICARE PART B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	127757	OTHER	MN	UCARE
3	8264KO	OTHER	MN	BCBS PROVIDER NUMBER
4	83-00013	OTHER	MN	MEDICA CHOICE PROV NO.
5	06G63KO	OTHER	MN	BCBS PROVIDER NUMBER
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	59-00164	OTHER	MN	MEDICA CHOICE PROVIDER NO

General Provider Information

NPI Number	:	1831192764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF KOOCHICHING

Provider Business Mailing Address
First Line	:	1000 5TH ST
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2243
Country	:	US
Telephone Number	:	218-283-7070
Fax Number	:	218-283-7050

Provider Business Practice Location Address
First Line	:	1000 5TH ST
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2243
Country	:	US
Telephone Number	:	218-283-7070
Fax Number	:	218-283-7050

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. DEREK FOSS
Credential	:
Telephone Number	:	218-283-7000

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/09/2024

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Directions to “COUNTY OF KOOCHICHING ” Practice Location

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