1902835903 NPI number — CAMP TWP-POLK COUNTY

Table of content: (NPI 1902835903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902835903 NPI number — CAMP TWP-POLK COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMP TWP-POLK COUNTY
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:
RUNNELLS FIRE DEPARTMENT
Provider Other Organization Name Type Code:
3
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:
1902835903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 56
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUNNELLS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50237-0056
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:
104 BROWN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUNNELLS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-208-0057
Provider Business Practice Location Address Fax Number:
515-966-2824
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
515-966-2241

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2771100 , 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: 40116 . This is a "BCBS WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 7096900 . This is a "PRINCIPAL HLTH CARE IA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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