1629072129 NPI number — CITY OF IDALOU

Table of content: (NPI 1629072129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629072129 NPI number — CITY OF IDALOU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF IDALOU
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:
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:
1629072129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1277
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IDALOU
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79329-1277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-787-6764
Provider Business Mailing Address Fax Number:
806-892-3298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
914 FRONTAGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IDALOU
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-892-2531
Provider Business Practice Location Address Fax Number:
806-892-3298
Provider Enumeration Date:
06/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COPELAND
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MGR
Authorized Official Telephone Number:
806-787-6764

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: P00104241 . This is a "MEDICARE RAIL ROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000015001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com