1083784912 NPI number — IDA SERVICES, INC.

Table of content: (NPI 1083784912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083784912 NPI number — IDA SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IDA SERVICES, INC.
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:
1083784912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51006-0016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-365-4339
Provider Business Mailing Address Fax Number:
712-365-4566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
651 FIRST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51006-0016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-365-4339
Provider Business Practice Location Address Fax Number:
712-365-4566
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
712-365-4339

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  NA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0240358 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W0721 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0124891 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W0519 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W5020 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1240358 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W1300 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W0720 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W0722 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W1430 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W1311 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W1431 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W0719 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W1414 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W1425 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W5021 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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