1932305349 NPI number — CITY OF GRAVETTE

Table of content: (NPI 1932305349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932305349 NPI number — CITY OF GRAVETTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF GRAVETTE
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:
GRAVETTE FIRE AND AMBULANCE
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:
1932305349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42002-9150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-744-9600
Provider Business Mailing Address Fax Number:
270-744-8642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 1ST AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAVETTE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-787-6600
Provider Business Practice Location Address Fax Number:
479-787-6162
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MADDOX
Authorized Official First Name:
KURT
Authorized Official Middle Name:
Authorized Official Title or Position:
MAYOR
Authorized Official Telephone Number:
479-787-7575

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: 175 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101128715 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47058 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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