1518091354 NPI number — CITADEL ASSOCIATION, INC.

Table of content: (NPI 1518091354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518091354 NPI number — CITADEL ASSOCIATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITADEL ASSOCIATION, INC.
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:
1518091354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 E CITADEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTOSI
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63664-1937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-438-3736
Provider Business Mailing Address Fax Number:
573-436-9200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 E CITADEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTOSI
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63664-1937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-438-3736
Provider Business Practice Location Address Fax Number:
573-436-9200
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EYE
Authorized Official First Name:
GEORGIA
Authorized Official Middle Name:
I.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
573-438-3736

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  1799-330 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 385H00000X , with the licence number: 1799-330 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 85140106 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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