1669526984 NPI number — MR. THOMAS EDWARD DEBUQUE CSAC

Table of content: MR. THOMAS EDWARD DEBUQUE CSAC (NPI 1669526984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669526984 NPI number — MR. THOMAS EDWARD DEBUQUE CSAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEBUQUE
Provider First Name:
THOMAS
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CSAC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1669526984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N3152 STATE ROAD 81
Provider Second Line Business Mailing Address:
GREEN COUNTY HUMAN SERVICES
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53566-9397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-328-9393
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N 3512 STATE ROAD 81
Provider Second Line Business Practice Location Address:
GREEN COUNTY HUMAN SERVICES
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-328-9393
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  11526 , 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)





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