1396842662 NPI number — CITY OF LOGAN

Table of content: (NPI 1396842662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396842662 NPI number — CITY OF LOGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF LOGAN
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:
LOGAN MNAOR COMMUNITY HEALTH SERVICES
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:
1396842662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 S. ADAMS ST.
Provider Second Line Business Mailing Address:
PO BOX 308
Provider Business Mailing Address City Name:
LOGAN
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-689-4201
Provider Business Mailing Address Fax Number:
785-689-7411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 S ADAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67646-5115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-689-4201
Provider Business Practice Location Address Fax Number:
785-689-7411
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCOMB
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
785-689-4201

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  N074003 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: N074001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: N074001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A-074-005 . This is a "STATE OF KANSAS HOME HEALTH AGENCY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100109100A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014001 . This is a "OCCUPATIONAL THERAPIST" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100071510B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115675 . This is a "PHYSICAL THERAPIST" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 140915 . This is a "PHYSICAL THERAPIST" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com