1306826359 NPI number — CITY OF WEST DES MOINES

Table of content: (NPI 1306826359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306826359 NPI number — CITY OF WEST DES MOINES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF WEST DES MOINES
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:
1306826359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 65320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50265-0320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-222-3652
Provider Business Mailing Address Fax Number:
515-273-0662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8055 MILLS CIVIC PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50266-3815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-222-3652
Provider Business Practice Location Address Fax Number:
515-273-0662
Provider Enumeration Date:
01/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUMERMUTH
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
515-222-3652

Provider Taxonomy Codes

  • Taxonomy code: 146L00000X , with the licence number:  2771300 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 2771300 , 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: 0068056 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 089832800 . This is a "BLACK LUNG/FECA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 806190609 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06805 . This is a "WELLMARK BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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