1649213752 NPI number — CITY OF BLAIRSTOWN

Table of content: (NPI 1649213752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649213752 NPI number — CITY OF BLAIRSTOWN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BLAIRSTOWN
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:
1649213752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 LOCUST ST NW
Provider Second Line Business Mailing Address:
PO BOX 270
Provider Business Mailing Address City Name:
BLAIRSTOWN
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-454-0078
Provider Business Mailing Address Fax Number:
319-454-6709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 MAIN ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAIRSTOWN
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-454-0078
Provider Business Practice Location Address Fax Number:
319-454-6709
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRITTAIN
Authorized Official First Name:
MELINDA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
319-454-0078

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2060900 , 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: C 16565 . This is a "UNITED AMER INS CO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001417 . This is a "PRINCIPAL LIFE INS CO" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: J09900019506 . This is a "SIERRA" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 590006388 . This is a "PALMETTO GBA-RR MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0165654 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41094 . This is a "WELLMARK BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0004654218 . This is a "AETNA PIN#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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