1114186988 NPI number — CITY OF HOFFMAN

Table of content: (NPI 1114186988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114186988 NPI number — CITY OF HOFFMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF HOFFMAN
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:
1114186988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 227
Provider Second Line Business Mailing Address:
127 MAIN AVE
Provider Business Mailing Address City Name:
HOFFMAN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56339-0227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-986-2448
Provider Business Mailing Address Fax Number:
320-986-6634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 MAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOFFMAN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56339-0227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-986-2448
Provider Business Practice Location Address Fax Number:
320-986-6634
Provider Enumeration Date:
06/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SATRE
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
MAYOR
Authorized Official Telephone Number:
320-986-2448

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 61198HD . This is a "BCBS OF MINNESOTA" identifier . This identifiers is of the category "OTHER".
  • Identifier: A334767200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030722056 . This is a "PRIMEWEST HEALTH SYSTEM" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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