1043433592 NPI number — CITY OF VALE

Table of content: (NPI 1043433592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043433592 NPI number — CITY OF VALE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF VALE
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:
1043433592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
252 B ST W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97918-1361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-473-3796
Provider Business Mailing Address Fax Number:
541-473-9667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
252 B ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97918-1361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-473-3796
Provider Business Practice Location Address Fax Number:
541-473-9667
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HESSE
Authorized Official First Name:
TODD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
BILLING CLERK
Authorized Official Telephone Number:
541-473-3796

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2302 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 205542 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000839000 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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