1790701142 NPI number — COUNTY OF IMPERIAL

Table of content: (NPI 1790701142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790701142 NPI number — COUNTY OF IMPERIAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF IMPERIAL
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:
IMPERIAL COUNTY PUBLIC HEALTH DEPARTMENT
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:
1790701142
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
935 BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL CENTRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92243-2349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-482-4438
Provider Business Mailing Address Fax Number:
760-352-7747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
935 BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-2349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-482-4438
Provider Business Practice Location Address Fax Number:
760-352-7747
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HODGKIN
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PUBLIC HEALTH DIRECTOR
Authorized Official Telephone Number:
760-482-4438

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CH05095 . This is a "CHDP - LEAD PROGRAM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: LAB70166F . This is a "LABORATORY MEDI-CAL #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZT11820F . This is a "CHDP PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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