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LAKE CITY #813
Complete NPI Record 1720121411
Local Education Agency (LEA) in Lake City, MN

NPI Status: Active since February 14, 2007

Contact Information

300 S GARDEN ST
LAKE CITY, MN
ZIP 55041
Phone: (654) 345-4553

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Enumeration Date
  18. Last Update Date
  19. Authorized Official Last Name
  20. Authorized Official First Name
  21. Authorized Official Title or Position
  22. Authorized Official Telephone Number
  23. Healthcare Provider Taxonomy Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Is Organization Subpart

Complete NPI Dataset

This page represents the complete record for NPI 1720121411. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1720121411
The last name of the provider. If the provider is an individual, this is the legal name.
Entity Type Code: 2
The first name of the provider, if the provider is an individual.
Employer Identification Number EIN: UNAVAIL
The middle name of the provider, if the provider is an individual.
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider First Line Business Mailing Address: PO BOX 454
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider Business Mailing Address City Name: LAKE CITY
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: MN
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 550410454
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 6513454553
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 300 S GARDEN ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: LAKE CITY
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: MN
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 550411664
The State code in the location of the provider being identified.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6543454553
The country code in the location address of the provider being identified.
Provider Enumeration Date: 2/14/2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/22/2020
The date the provider was assigned a unique identifier (assigned an NPI).
Authorized Official Last Name: ADAMS
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: AMY
The first name of the authorized official.
Authorized Official Title or Position: DIRECTOR OF SPECIAL EDUCATION
The title or position of the authorized official.
Authorized Official Telephone Number: 5077673339
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 251300000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N