1467593129 NPI number — CITY OF BURLINGTON

Table of content: (NPI 1467593129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467593129 NPI number — CITY OF BURLINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BURLINGTON
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:
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:
1467593129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 WASHINGTON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52601-5515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-753-8396
Provider Business Mailing Address Fax Number:
319-754-9545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
418 VALLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52601-5515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-753-8396
Provider Business Practice Location Address Fax Number:
319-754-9545
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TREXEL
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
319-753-8396

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  2290100IA , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0014415 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01441 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 37-1230188 . This is a "ILLINOIS MEDICAID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 590043365 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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