1518087444 NPI number — CERRO GORDO COUNTY BOARD OF HEALTH

Table of content: (NPI 1518087444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518087444 NPI number — CERRO GORDO COUNTY BOARD OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CERRO GORDO COUNTY BOARD OF HEALTH
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:
CERRO GORDO COUNTY DEPARTMENT OF PUBLIC HEALTH
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:
1518087444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2570 4TH ST SW STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASON CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50401-4665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-423-9304
Provider Business Mailing Address Fax Number:
641-421-9350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2570 4TH ST SW SUITE #1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASON CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50401-3435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-421-9300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HANFT
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH DIRECTOR
Authorized Official Telephone Number:
641-421-9300

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; 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" .

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

  • Identifier: 0670547 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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