1013152776 NPI number — DES MOINES VALLEY HEALTH AND HUMAN SERVICES

Table of content: (NPI 1013152776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013152776 NPI number — DES MOINES VALLEY HEALTH AND HUMAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DES MOINES VALLEY HEALTH AND HUMAN SERVICES
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:
1013152776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDOM
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56101-9998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-831-1891
Provider Business Mailing Address Fax Number:
507-831-0126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56143-9588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-847-4000
Provider Business Practice Location Address Fax Number:
507-847-5616
Provider Enumeration Date:
12/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR OF BUSINESS OPER
Authorized Official Telephone Number:
507-831-1891

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: A000032900 . This is a "UMPI" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 000032900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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