1730187113 NPI number — COUNTY OF JEFFERSON

Table of content: (NPI 1730187113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730187113 NPI number — COUNTY OF JEFFERSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF JEFFERSON
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:
HOSPICE OF JEFFERSON COUNTY
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:
1730187113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 WALNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSKALOOSA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66066-4200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-863-2447
Provider Business Mailing Address Fax Number:
785-863-3323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSKALOOSA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66066-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-863-2447
Provider Business Practice Location Address Fax Number:
785-863-3323
Provider Enumeration Date:
07/11/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CZOCH
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
HOME CARE DIRECTOR
Authorized Official Telephone Number:
785-863-2447

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  Z044001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00818 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100089340E , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".