1417061680 NPI number — BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES

Table of content: (NPI 1417061680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417061680 NPI number — BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
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:
Provider Other Organization Name Type Code:
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:
1417061680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 E LA SALLE AVE RM 338
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARRON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54812-1546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 E LA SALLE AVE RM 338
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARRON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54812-1546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-537-5691
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEMERS
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
715-537-5691

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 43430300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32978771 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44002000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43102800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43070200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43430700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41280100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42009200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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