1588669485 NPI number — CITY OF SARGENT

Table of content: (NPI 1588669485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588669485 NPI number — CITY OF SARGENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SARGENT
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:
1588669485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 CHATHAM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERWYN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68814-2723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-935-1569
Provider Business Mailing Address Fax Number:
308-935-9131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 N 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARGENT
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68874-4214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-527-4255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROPERS
Authorized Official First Name:
LOUIE
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY TREASURER
Authorized Official Telephone Number:
308-527-3502

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1257 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09462 . This is a "BLUECROSS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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