1871554204 NPI number — CITY OF COLUMBUS

Table of content: (NPI 1871554204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871554204 NPI number — CITY OF COLUMBUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF COLUMBUS
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:
1871554204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1677
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68602-1677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-562-4224
Provider Business Mailing Address Fax Number:
402-563-1380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4630 HOWARD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68601-2158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-564-8127
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VASICEK
Authorized Official First Name:
TARA
Authorized Official Middle Name:
Authorized Official Title or Position:
CITY ADMINISTRATOR
Authorized Official Telephone Number:
402-562-4233

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  5015 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200357740 A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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