1164490058 NPI number — CITY OF CASTLE ROCK

Table of content: (NPI 1164490058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164490058 NPI number — CITY OF CASTLE ROCK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CASTLE ROCK
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:
CASTLE ROCK FIRE & EMS
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:
1164490058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASTLE ROCK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98611-0370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-274-4413
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
146 A STREET SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLE ROCK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-274-4413
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOREIS
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
360-274-4413

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  08M01 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 337443500 . This is a "FEDERAL OWCP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0029775 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8905072 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CA0852 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 158293 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9158809 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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