1104930866 NPI number — COUNTY OF ADAMS

Table of content: (NPI 1104930866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104930866 NPI number — COUNTY OF ADAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF ADAMS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADAMS COUNTY HEALTH & HUMAN SERVICES DEPARTMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104930866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 E NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRIENDSHIP
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53934-9443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-339-4505
Provider Business Mailing Address Fax Number:
608-339-4593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 E NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRIENDSHIP
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53934-9443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-339-4505
Provider Business Practice Location Address Fax Number:
608-339-4593
Provider Enumeration Date:
08/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
Authorized Official Title or Position:
FISCAL MANAGER
Authorized Official Telephone Number:
608-339-4505

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  1253 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 43109000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42117800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43079900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43070000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".