1144545419 NPI number — CITY OF ELY

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 1144545419 NPI number — CITY OF ELY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF ELY
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:
CITY OF ELY FIRE DEPARTMENT
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:
1144545419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 MILL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89301-1940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-289-2430
Provider Business Mailing Address Fax Number:
775-289-1463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1780 GREAT BASIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89301-3138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-289-6633
Provider Business Practice Location Address Fax Number:
775-289-3122
Provider Enumeration Date:
03/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
ROSS
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
775-289-6633

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1144545419 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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