1962567081 NPI number — STATE OF IOWA HUMAN SERVICES MT. PLEASANT

Table of content: (NPI 1962567081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962567081 NPI number — STATE OF IOWA HUMAN SERVICES MT. PLEASANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF IOWA HUMAN SERVICES MT. PLEASANT
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:
MENTAL HEALTH INSTITUTE PHARMACY
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:
1962567081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 E WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52641-1804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52641-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-385-7231
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CURRAN
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
319-385-7231

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X , with the licence number:  447 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1622922 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".