1538165766 NPI number — COUNTY OF LA CROSSE

Table of content: (NPI 1538165766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538165766 NPI number — COUNTY OF LA CROSSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF LA CROSSE
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:
1538165766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 4TH ST N
Provider Second Line Business Mailing Address:
FL 2
Provider Business Mailing Address City Name:
LA CROSSE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54601-3228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-785-9850
Provider Business Mailing Address Fax Number:
608-785-9846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 4TH ST N
Provider Second Line Business Practice Location Address:
FL 2
Provider Business Practice Location Address City Name:
LA CROSSE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54601-3228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-785-9850
Provider Business Practice Location Address Fax Number:
608-785-9846
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINE
Authorized Official First Name:
AUDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
608-792-3713

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  44000400 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 41853100 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41853100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43082800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43103500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41520000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44000400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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