1730296245 NPI number — LOGAN VOLUNTEER FIRE & RESCUE ASSOCIATION

Table of content: (NPI 1730296245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730296245 NPI number — LOGAN VOLUNTEER FIRE & RESCUE ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOGAN VOLUNTEER FIRE & RESCUE ASSOCIATION
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:
LOGAN FIRE RESCUE ASSOCIATION
Provider Other Organization Name Type Code:
3
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:
1730296245
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOGAN
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-644-2579
Provider Business Mailing Address Fax Number:
712-644-2579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 NORTH THIRD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-644-2579
Provider Business Practice Location Address Fax Number:
712-644-2579
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUCY
Authorized Official First Name:
DEREK
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
712-644-2579

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2430200 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1730296245 . This is a "BLUE CROSS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0231712 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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