1396180733 NPI number — TOWN OF MILLS

Table of content: (NPI 1396180733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396180733 NPI number — TOWN OF MILLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF MILLS
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:
MILLS F-D
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:
1396180733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 641880
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68164-7880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-572-4019
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 LAKEVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLS
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82604-2311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-234-8481
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BEALL
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CAPTAIN
Authorized Official Telephone Number:
307-234-8481

Provider Taxonomy Codes

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

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

  • Identifier: 57 . This is a "WY" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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