1790901627 NPI number — COUNTY OF IRON

Table of content: (NPI 1790901627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790901627 NPI number — COUNTY OF IRON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF IRON
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:
1790901627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 TACONITE ST
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
HURLEY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54534-1546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-561-3636
Provider Business Mailing Address Fax Number:
715-561-2128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 TACONITE ST
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
HURLEY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54534-1546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-561-3636
Provider Business Practice Location Address Fax Number:
715-561-2128
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOLSON-JANOV
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
715-561-3636

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2347 , 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: 42225100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43081900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32771700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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