1902958150 NPI number — CITY OF PLEASANT HILL

Table of content: (NPI 1902958150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902958150 NPI number — CITY OF PLEASANT HILL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF PLEASANT HILL
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:
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:
1902958150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5151 MAPLE DR
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
PLEASANT HILL
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50327-8456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-262-9360
Provider Business Mailing Address Fax Number:
515-262-9766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5151 MAPLE DR
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
PLEASANT HILL
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50327-8456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-262-9360
Provider Business Practice Location Address Fax Number:
515-262-9766
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
IVAN
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
ASST. CHEIF PHFD
Authorized Official Telephone Number:
515-262-9360

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  7720700 , 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: 0721897 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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