1386720563 NPI number — COUNTY OF VAN BUREN

Table of content: (NPI 1386720563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386720563 NPI number — COUNTY OF VAN BUREN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF VAN BUREN
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:
1386720563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 514
Provider Second Line Business Mailing Address:
905 BROAD ST
Provider Business Mailing Address City Name:
KEOSAUQUA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52565-0514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-293-3431
Provider Business Mailing Address Fax Number:
319-293-3609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 BROAD ST COURTHOUSE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEOSAUQUA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52565-0514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-293-3431
Provider Business Practice Location Address Fax Number:
319-293-3609
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
LINDEE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
NURSE ADMINISTRATOR
Authorized Official Telephone Number:
319-293-3431

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 67111 . This is a "BCBS OF IA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0671115 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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