1538220926 NPI number — CITY OF MAPLE LAKE

Table of content: (NPI 1538220926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538220926 NPI number — CITY OF MAPLE LAKE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF MAPLE LAKE
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:
1538220926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 MAPLE AVE S
Provider Second Line Business Mailing Address:
PO BOX 757
Provider Business Mailing Address City Name:
MAPLE LAKE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55358-4558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-963-3611
Provider Business Mailing Address Fax Number:
320-963-6612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 MAPLE AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55358-4558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-963-3611
Provider Business Practice Location Address Fax Number:
320-963-6612
Provider Enumeration Date:
12/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
YAGER
Authorized Official First Name:
LEE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CITY CLERK
Authorized Official Telephone Number:
320-963-3611

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  147 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 55023MA . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 25107-469153224 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 602067400 . This is a "MN MA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".