1942274436 NPI number — TOWN OF CHURDAN

Table of content: (NPI 1942274436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942274436 NPI number — TOWN OF CHURDAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF CHURDAN
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:
CHURDAN FIRE AND RESCUE
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:
1942274436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 SAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHURDAN
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-389-3790
Provider Business Mailing Address Fax Number:
515-389-3334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 SAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHURDAN
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-389-3790
Provider Business Practice Location Address Fax Number:
515-389-3334
Provider Enumeration Date:
02/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GEBHART
Authorized Official First Name:
BILL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
515-389-3790

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2370300 , 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: 0232371 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590014446 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 29057 . This is a "WELLMARK BLUE CROSS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".