1225038359 NPI number — CITY OF MARSHFIELD

Table of content: MS. KATHLEEN PEGGY ADAMEK L.C.S.W. (NPI 1154465920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225038359 NPI number — CITY OF MARSHFIELD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF MARSHFIELD
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:
6
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:
1225038359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
514 E 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54449-4516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-384-4600
Provider Business Mailing Address Fax Number:
715-384-7831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
514 EAST 4TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54449-4516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-486-2094
Provider Business Practice Location Address Fax Number:
715-384-8868
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BAKOS
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY FIRE CHIEF-EMS
Authorized Official Telephone Number:
715-486-2093

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  6000285 , 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: 41324100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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