1508071200 NPI number — CITY OF MITCHELL

Table of content: (NPI 1508071200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508071200 NPI number — CITY OF MITCHELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF MITCHELL
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:
1508071200
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:
202 SW HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MITCHELL
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97750-0097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-447-5011
Provider Business Mailing Address Fax Number:
541-416-4999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 SW HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MITCHELL
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97750-0097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-447-5011
Provider Business Practice Location Address Fax Number:
541-416-4999
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEASHAM
Authorized Official First Name:
DARLA
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
BILLING CLERK
Authorized Official Telephone Number:
541-447-5011

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3503-E227206 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 104430 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com