1710048020 NPI number — CITY OF SHELL ROCK

Table of content: (NPI 1710048020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710048020 NPI number — CITY OF SHELL ROCK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SHELL ROCK
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:
1710048020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 522
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELL ROCK
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50670-0522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-885-6555
Provider Business Mailing Address Fax Number:
319-885-6556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 S CHERRY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELL ROCK
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50670-0522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-885-6555
Provider Business Practice Location Address Fax Number:
319-885-6556
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NIEMAN
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPT CITY CLERK
Authorized Official Telephone Number:
319-885-6555

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2120600 , 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: 0007625 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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