1326219171 NPI number — CITY OF FOSSIL

Table of content: (NPI 1326219171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326219171 NPI number — CITY OF FOSSIL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF FOSSIL
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:
1326219171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 467
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOSSIL
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97830-0467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-763-2698
Provider Business Mailing Address Fax Number:
541-763-2124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOSSIL
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-763-2698
Provider Business Practice Location Address Fax Number:
541-763-2124
Provider Enumeration Date:
03/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HUNT
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
GWENDOLYN
Authorized Official Title or Position:
CITY RECORDER
Authorized Official Telephone Number:
541-763-2698

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  3501 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000RGBDD . This is a "MEDICARE PIN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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