1255470332 NPI number — CITY OF BLOOMING PRAIRIE

Table of content: (NPI 1255470332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255470332 NPI number — CITY OF BLOOMING PRAIRIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BLOOMING PRAIRIE
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:
1255470332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 363
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMING PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-583-7573
Provider Business Mailing Address Fax Number:
507-583-4520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 2ND AVENUE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMING PRAIRIE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-583-7573
Provider Business Practice Location Address Fax Number:
507-583-4520
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOLLAND
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
CLEONE
Authorized Official Title or Position:
DEPUTY CITY CLERK TREASURER
Authorized Official Telephone Number:
507-583-7573

Provider Taxonomy Codes

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

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

  • Identifier: 590014914 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 167883 . This is a "UCARE MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 493267600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35019BL . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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