1447379284 NPI number — INCA COMMNITY SERVICES, INC.

Table of content: (NPI 1447379284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447379284 NPI number — INCA COMMNITY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INCA COMMNITY SERVICES, 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:
INCA CAREER OPPORTUNITIES
Provider Other Organization Name Type Code:
3
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:
1447379284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 807
Provider Second Line Business Mailing Address:
301 WEST 10TH STREET
Provider Business Mailing Address City Name:
ATOKA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74525-0807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-889-7393
Provider Business Mailing Address Fax Number:
580-889-7393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATOKA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74525-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-889-7393
Provider Business Practice Location Address Fax Number:
580-889-7393
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOBBS
Authorized Official First Name:
KRISTY
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
580-889-7393

Provider Taxonomy Codes

  • Taxonomy code: 251T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100680650F , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100680650G , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100680650B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100680650D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100680650A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100680650H , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100680650C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100680650E , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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