1902900400 NPI number — PETER ALFRED BADAMI LISW

Table of content: PETER ALFRED BADAMI LISW (NPI 1902900400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902900400 NPI number — PETER ALFRED BADAMI LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADAMI
Provider First Name:
PETER
Provider Middle Name:
ALFRED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1902900400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 E ALTA VISTA
Provider Second Line Business Mailing Address:
ORHC CLINICS CLINIC BILLING
Provider Business Mailing Address City Name:
OTTUMWA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-684-3053
Provider Business Mailing Address Fax Number:
641-683-2855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 E ALTA VISTA
Provider Second Line Business Practice Location Address:
BEHAVIORAL HEALTH COUNSELING SERVICES
Provider Business Practice Location Address City Name:
OTTUMWA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-684-3138
Provider Business Practice Location Address Fax Number:
641-684-3198
Provider Enumeration Date:
09/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  00401 , 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)