1356383657 NPI number — CITY OF LENOX

Table of content: (NPI 1356383657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356383657 NPI number — CITY OF LENOX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF LENOX
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:
LENOX AMBULANCE SERVICE
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:
1356383657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENOX
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50851-1242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-333-2228
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOX
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50851-1447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-333-2914
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BEACH-SICKELS
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
641-344-3020

Provider Taxonomy Codes

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

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

  • Identifier: 0153841 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".