1679566327 NPI number — COUNTY OF SAWYER

Table of content: (NPI 1679566327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679566327 NPI number — COUNTY OF SAWYER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SAWYER
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:
1679566327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10610 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 224
Provider Business Mailing Address City Name:
HAYWARD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54843-6595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-634-4874
Provider Business Mailing Address Fax Number:
715-634-3580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10610 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 224
Provider Business Practice Location Address City Name:
HAYWARD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54843-6595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-634-4874
Provider Business Practice Location Address Fax Number:
715-634-3580
Provider Enumeration Date:
08/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GRAHOVAC
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
AGENCY DIRECTOR
Authorized Official Telephone Number:
715-638-3334

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 42552100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43075400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43084500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41521800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41852200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42115700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43103000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42009300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44000300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600000110 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43426200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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