1477727345 NPI number — MANITOWOC COUNTY COURTHOUSE COMPTROLLERS OFFICE

Table of content: (NPI 1477727345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477727345 NPI number — MANITOWOC COUNTY COURTHOUSE COMPTROLLERS OFFICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANITOWOC COUNTY COURTHOUSE COMPTROLLERS OFFICE
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:
COUNTY OWNED OPERATED FACILITY
Provider Other Organization Name Type Code:
5
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:
1477727345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1177
Provider Second Line Business Mailing Address:
926 SOUTH 8TH STREET
Provider Business Mailing Address City Name:
MANITOWOC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54221-1177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-683-4230
Provider Business Mailing Address Fax Number:
920-683-4908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
926 SOUTH 8TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANITOWOC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54221-1177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-683-4230
Provider Business Practice Location Address Fax Number:
920-683-4908
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DODGE
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CO DIRECTOR
Authorized Official Telephone Number:
920-683-4230

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1555 , 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: 43106400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41763300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43079700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32977571 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42139400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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