1982895942 NPI number — COUNCIL BLUFFS COMMUNITY HEALTH CENTER

Table of content: (NPI 1982895942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982895942 NPI number — COUNCIL BLUFFS COMMUNITY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNCIL BLUFFS COMMUNITY HEALTH CENTER
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:
1982895942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 WEST BROADWAY
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
COUNCIL BLUFFS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51503-9040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-256-6577
Provider Business Mailing Address Fax Number:
712-325-1932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 COLLEGE RD
Provider Second Line Business Practice Location Address:
A104
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51503-1057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-325-3351
Provider Business Practice Location Address Fax Number:
712-325-3739
Provider Enumeration Date:
08/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNOW
Authorized Official First Name:
GERRI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
AR MANAGER
Authorized Official Telephone Number:
712-256-6577

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 16D0949735 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0188946 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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