1780636803 NPI number — CITY OF DUBUQUE

Table of content: (NPI 1780636803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780636803 NPI number — CITY OF DUBUQUE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF DUBUQUE
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:
1780636803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 W 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBUQUE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52001-4839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 W 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBUQUE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52001-4839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-589-4194
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JANECKE
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS SUPERVISOR
Authorized Official Telephone Number:
563-589-4194

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0016782 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01678 . This is a "BCBS IA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 139985400 . This is a "ACS HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8181709 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1012392 . This is a "PHYSICIAN'S PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: IA0101 . This is a "HERITAGE MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81164800 . This is a "HIRSP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 000001678 . This is a "ADVOCARE MCHMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 139985400 . This is a "WORKER'S COMPENSATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: IA0101 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040576 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41120 . This is a "NETWORK HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81164800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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