1073673463 NPI number — CITY OF POLK CITY

Table of content: (NPI 1073673463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073673463 NPI number — CITY OF POLK CITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF POLK CITY
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:
1073673463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 426
Provider Second Line Business Mailing Address:
112 3RD ST
Provider Business Mailing Address City Name:
POLK CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50226-0034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-984-6233
Provider Business Mailing Address Fax Number:
515-984-6792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 W. VAN DORN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POLK CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50226-0034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-984-6304
Provider Business Practice Location Address Fax Number:
515-984-6792
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUBBINS
Authorized Official First Name:
DAN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
515-984-6304

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: 2771000 , 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: 0142760 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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