1447344585 NPI number — TOWN OF CLAYTON

Table of content: (NPI 1447344585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447344585 NPI number — TOWN OF CLAYTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF CLAYTON
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:
1447344585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10802 FARNAM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68154-3237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
531-895-5853
Provider Business Mailing Address Fax Number:
877-343-0131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CHESTNUT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-374-8331
Provider Business Practice Location Address Fax Number:
505-374-8497
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARNES
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLERK TREASURER
Authorized Official Telephone Number:
575-374-8331

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  14760 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201080024 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0580613 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590005160 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: NM00R021 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 162330801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: R0712 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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