1730187113 NPI number — COUNTY OF JEFFERSON

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730187113 NPI number — COUNTY OF JEFFERSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF JEFFERSON
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:
HOSPICE OF JEFFERSON COUNTY
Provider Other Organization Name Type Code:
5
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:
1730187113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 WALNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSKALOOSA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66066-4200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-863-2447
Provider Business Mailing Address Fax Number:
785-863-3323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSKALOOSA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66066-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-863-2447
Provider Business Practice Location Address Fax Number:
785-863-3323
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CZOCH
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
HOME CARE DIRECTOR
Authorized Official Telephone Number:
785-863-2447

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  Z044001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00818 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100089340E , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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