1114925617 NPI number — CITY OF IDAHO FALLS

Table of content: (NPI 1114925617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114925617 NPI number — CITY OF IDAHO FALLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF IDAHO FALLS
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:
1114925617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 269110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95826-9110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-669-4613
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
343 E ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IDAHO FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-612-8452
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DAY
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
208-612-8173

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  8705 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 32466 . This is a "DMBA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 421 . This is a "STATE INSURANCE FUND" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 8180029 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 197470 . This is a "ALTIUS HEALTH PLANS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: E0229 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010034871 . This is a "REGENCE BLUE SHIELD OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: DA0003 . This is a "HEALTH NET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 213131 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590157453 . This is a "PALMETTO, GBA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 826000280 . This is a "TRICARE - WBS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002806100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0441688 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 274655001 . This is a "EMPLOYER'S MUTUAL" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 60054 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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