1932482973 NPI number — CITY OF FORT DODGE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932482973 NPI number — CITY OF FORT DODGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF FORT DODGE
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:
1932482973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
819 1ST AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT DODGE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50501-4739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-573-7156
Provider Business Mailing Address Fax Number:
515-573-2084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT DODGE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50501-4247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-576-1031
Provider Business Practice Location Address Fax Number:
515-955-2396
Provider Enumeration Date:
09/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LUERS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
515-576-1031

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1234567 , 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: 1932482973 . This is a "WELLMARK, BCBS OF IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1932482973 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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