1437228699 NPI number — CITY OF LIBERTY

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 1437228699 NPI number — CITY OF LIBERTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF LIBERTY
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:
1437228699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATSONTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17777-0055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-538-4488
Provider Business Mailing Address Fax Number:
570-538-1556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W MISSISSIPPI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64068-1625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-792-6005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SNIDER
Authorized Official First Name:
PRESTON
Authorized Official Middle Name:
M
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
816-439-4310

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  047031 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 800464604 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100351260A . This is a "KS MEDICAID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 03766014 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 826590824 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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