1033140272 NPI number — CITY OF SERGEANT BLUFF

Table of content: (NPI 1033140272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033140272 NPI number — CITY OF SERGEANT BLUFF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SERGEANT BLUFF
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:
SERGEANT BLUFF FIRE & RESCUE
Provider Other Organization Name Type Code:
5
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:
1033140272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 PORT NEAL ROAD
Provider Second Line Business Mailing Address:
PO BOX 609
Provider Business Mailing Address City Name:
SERGEANT BLUFF
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51054-0609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-943-5000
Provider Business Mailing Address Fax Number:
712-943-5006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 PORT NEAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SERGEANT BLUFF
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51054-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-251-6923
Provider Business Practice Location Address Fax Number:
712-943-5006
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAUTERS
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT CHIEF
Authorized Official Telephone Number:
712-943-5000

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15476 . This is a "BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0154765 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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