1982693495 NPI number — CITY OF DE PERE

Table of content: (NPI 1982693495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982693495 NPI number — CITY OF DE PERE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF DE PERE
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:
1982693495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 LEWIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DE PERE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54115-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-339-4085
Provider Business Mailing Address Fax Number:
920-403-7883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 LEWIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DE PERE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54115-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-339-4085
Provider Business Practice Location Address Fax Number:
920-403-7883
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RUBIN
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
920-339-4085

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  6001025 , 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)

  • Identifier: 41328800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000083192 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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