1407978893 NPI number — CITY OF MARIETTA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407978893 NPI number — CITY OF MARIETTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF MARIETTA
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:
1407978893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 SECOND ST. NORTH
Provider Second Line Business Mailing Address:
PO BOX 123
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56257-0123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-668-2375
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 3RD AVE. NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56257-0123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-668-2375
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STOICK
Authorized Official First Name:
DOROTHY
Authorized Official Middle Name:
CLARA
Authorized Official Title or Position:
CITY CLERK
Authorized Official Telephone Number:
320-668-2375

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0149 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 44343MA . This is a "BLUE CROSS ID #GROUP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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