1699704734 NPI number — CITY OF ELLSWORTH

Table of content: (NPI 1699704734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699704734 NPI number — CITY OF ELLSWORTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF ELLSWORTH
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:
ELLSWORTH FIRE AND EMS
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:
1699704734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLSWORTH
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50075-0310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-882-9911
Provider Business Mailing Address Fax Number:
605-882-9922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1528 DEWITT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50075-5006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-882-9911
Provider Business Practice Location Address Fax Number:
877-882-9922
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNT REPRESENTATIVE
Authorized Official Telephone Number:
877-882-9911

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  2406200 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 2406200 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 38556 . This is a "BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0486381 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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