1154342327 NPI number — CITY OF CLEAR LAKE CITY CLERK

Table of content: (NPI 1154342327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154342327 NPI number — CITY OF CLEAR LAKE CITY CLERK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CLEAR LAKE CITY CLERK
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:
1154342327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 1ST AVE NW
Provider Second Line Business Mailing Address:
PO BOX 480
Provider Business Mailing Address City Name:
WEST BEND
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50597-0480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-357-2186
Provider Business Mailing Address Fax Number:
641-357-7172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 1ST AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEAR LAKE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50428-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-357-2186
Provider Business Practice Location Address Fax Number:
641-357-7172
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLORY
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
CITY ADMINISTRATOR
Authorized Official Telephone Number:
641-357-5267

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2170400 , 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: 0492504 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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