1801890892 NPI number — HOSPICE OF DUBUQUE

Table of content: (NPI 1801890892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801890892 NPI number — HOSPICE OF DUBUQUE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF DUBUQUE
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:
1801890892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1670 JOHN F KENNEDY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBUQUE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52002-5106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-582-1220
Provider Business Mailing Address Fax Number:
563-582-8089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1670 JOHN F KENNEDY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBUQUE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52002-5106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-582-1220
Provider Business Practice Location Address Fax Number:
563-582-8089
Provider Enumeration Date:
06/08/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NOEL
Authorized Official First Name:
LAVONNE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
563-582-1220

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  2001618 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: 562 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , 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: 3000738 . This is a "MEDICAL ASSOCIATES HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 43187800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61514 . This is a "WELLMARK BCBS OF IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0615146 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".