1447344585 NPI number — TOWN OF CLAYTON

Table of Contents

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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