1366596736 NPI number — CITY OF CLIVE

Table of content: (NPI 1366596736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366596736 NPI number — CITY OF CLIVE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CLIVE
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:
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:
1366596736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8800 HICKMAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIVE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50325-5338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-223-1595
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8505 HARBACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIVE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50325-1077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-223-7723
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRAHAM
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
CITY CLERK
Authorized Official Telephone Number:
515-223-6220

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2770300 , 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: 07315 . This is a "WELLMARK BC BS NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0081562 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com