1023238615 NPI number — CITY OF BONDURANT

Table of content: (NPI 1023238615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023238615 NPI number — CITY OF BONDURANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BONDURANT
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:
6
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:
1023238615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 2ND ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BONDURANT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50035-1021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-967-4902
Provider Business Mailing Address Fax Number:
515-967-4902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 2ND ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONDURANT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50035-1021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-967-4902
Provider Business Practice Location Address Fax Number:
515-967-4902
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOGAARDS
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
JAYE
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
515-210-3349

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X , with the licence number:  2771800 , 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: 0189092 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com