1942285911 NPI number — NIAGARA AREA EMERGENCY UNIT, INC

Table of content: JEFFREY JOHN PHARMACY TECHNICIAN (NPI 1063234714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942285911 NPI number — NIAGARA AREA EMERGENCY UNIT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NIAGARA AREA EMERGENCY UNIT, INC
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:
1942285911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 66
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIAGARA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54151-0066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-251-3136
Provider Business Mailing Address Fax Number:
715-251-3136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1241 JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NIAGARA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54151-1233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-251-3136
Provider Business Practice Location Address Fax Number:
715-251-3136
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RABIDEAU
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
CLETUS
Authorized Official Title or Position:
BILLER
Authorized Official Telephone Number:
715-251-3136

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  6001089 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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