1194991299 NPI number — PEPIN COUNTY DEPARTMENT OF HUMAN SERVICES

Table of content: (NPI 1194991299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194991299 NPI number — PEPIN COUNTY DEPARTMENT OF HUMAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEPIN COUNTY DEPARTMENT OF HUMAN SERVICES
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:
1194991299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
740 7TH AVE W
Provider Second Line Business Mailing Address:
PO BOX 39
Provider Business Mailing Address City Name:
DURAND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54736-1628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-672-8941
Provider Business Mailing Address Fax Number:
715-672-8593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 7TH AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURAND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54736-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-672-8941
Provider Business Practice Location Address Fax Number:
715-672-8593
Provider Enumeration Date:
05/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHOUINARD
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
FISCAL MANAGER
Authorized Official Telephone Number:
715-672-8941

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100014934 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43111200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41407000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43078000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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