1487732400 NPI number — CITY OF PLYMOUTH

Table of content: ASHLEY PEASLEY (NPI 1548814544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487732400 NPI number — CITY OF PLYMOUTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF PLYMOUTH
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:
1487732400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 N MICHIGAN ST
Provider Second Line Business Mailing Address:
P O BOX 492
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46563-2133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-936-2124
Provider Business Mailing Address Fax Number:
574-936-4371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46563-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-936-8291
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GORSKI
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CLERK TREASURER
Authorized Official Telephone Number:
574-936-2124

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0169 , 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: 100282150 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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