1467537829 NPI number — CITY OF MONTICELLO

Table of content: (NPI 1467537829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467537829 NPI number — CITY OF MONTICELLO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF MONTICELLO
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:
1467537829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 W WASHINGTON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTICELLO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47960-2163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-538-8278
Provider Business Mailing Address Fax Number:
580-628-2273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
911 W SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47960-4620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-538-3151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLAKE
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
ASSISTANT FIRE CHIEF
Authorized Official Telephone Number:
574-583-3151

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1188 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000196155 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100281400A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590164422 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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