1417142480 NPI number — REGION XII COUNCIL OF GOVERNMENTS, INC.

Table of content: (NPI 1417142480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417142480 NPI number — REGION XII COUNCIL OF GOVERNMENTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGION XII COUNCIL OF GOVERNMENTS, INC.
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:
1417142480
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1009 E ANTHONY ST
Provider Second Line Business Mailing Address:
P.O. BOX 768
Provider Business Mailing Address City Name:
CARROLL
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51401-3842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-792-9914
Provider Business Mailing Address Fax Number:
712-792-1751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1009 E ANTHONY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLL
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51401-3842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-792-9914
Provider Business Practice Location Address Fax Number:
712-792-1751
Provider Enumeration Date:
09/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FELDMAN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
TRANSIT MANAGER
Authorized Official Telephone Number:
712-792-9914

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , 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: 0134742 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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