1487772539 NPI number — DIXON UNIFIED SCHOOLS DISTRICT

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 1487772539 NPI number — DIXON UNIFIED SCHOOLS DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIXON UNIFIED SCHOOLS DISTRICT
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:
1487772539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 S. FIRST ST.
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
DIXON
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
95620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-678-9533
Provider Business Mailing Address Fax Number:
707-678-0298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 S. FIRST ST.
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
DIXON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-678-9533
Provider Business Practice Location Address Fax Number:
707-678-0298
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOM
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
LEA COORDINATOR
Authorized Official Telephone Number:
707-678-9533

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SS4870532 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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