1063504702 NPI number — CITY OF DUBUQUE HEALTH SERVICES DEPARTMENT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063504702 NPI number — CITY OF DUBUQUE HEALTH SERVICES DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF DUBUQUE HEALTH SERVICES DEPARTMENT
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:
1063504702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBUQUE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52001-4732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-589-4181
Provider Business Mailing Address Fax Number:
563-589-4299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBUQUE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52001-4732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-589-4181
Provider Business Practice Location Address Fax Number:
563-589-4299
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CORRIGAN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ROSE
Authorized Official Title or Position:
PUBLIC HEALTH SPECIALIST
Authorized Official Telephone Number:
563-589-4181

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , 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: 0184986 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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