1528019049 NPI number — CITY OF PACIFIC JUNCTION

Table of content: (NPI 1528019049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528019049 NPI number — CITY OF PACIFIC JUNCTION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF PACIFIC JUNCTION
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:
1528019049
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:
PO BOX 337
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PACIFIC JUNCTION
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51561-0337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-622-8177
Provider Business Mailing Address Fax Number:
712-622-8400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PACIFIC JUNCTION
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51561-0337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-887-3553
Provider Business Practice Location Address Fax Number:
515-887-2000
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAYO
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
712-622-8177

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2650400 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200369430A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01395 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: P00018356 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10025347200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8100234 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9011250 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0013953 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com