1649323429 NPI number — ROCKWELL CITY LYTTON SCHOOL DISTRICT

Table of content: (NPI 1649323429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649323429 NPI number — ROCKWELL CITY LYTTON SCHOOL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKWELL CITY LYTTON SCHOOL DISTRICT
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:
1649323429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 TONAWANDA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKWELL CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-297-7341
Provider Business Mailing Address Fax Number:
712-297-7320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 TONAWANDA AVE
Provider Second Line Business Practice Location Address:
ROCKWELL CITY LYTTON HIGH SCHOOL
Provider Business Practice Location Address City Name:
ROCKWELL CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-297-7341
Provider Business Practice Location Address Fax Number:
712-297-7320
Provider Enumeration Date:
01/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ERICSSON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
SCHOOL NURSE REGISTERED NURSE
Authorized Official Telephone Number:
712-297-7341

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  097435 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1649323429 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".