1992822266 NPI number — CITY OF RACINE HEALTH DEPARTMENT

Table of content: (NPI 1992822266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992822266 NPI number — CITY OF RACINE HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF RACINE HEALTH DEPARTMENT
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:
1992822266
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:
730 WASHINGTON AVE
Provider Second Line Business Mailing Address:
ROOM 106
Provider Business Mailing Address City Name:
RACINE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53403-1146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-636-9201
Provider Business Mailing Address Fax Number:
262-636-9564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
ROOM 106
Provider Business Practice Location Address City Name:
RACINE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53403-1146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-636-9201
Provider Business Practice Location Address Fax Number:
262-636-9564
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRAMMER
Authorized Official First Name:
JANELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH ADMINISTRATOR
Authorized Official Telephone Number:
262-636-9202

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 43084100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2133524001 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 44007900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32932300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41862300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590219 . This is a "DEAN HEALTH PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com