1770643132 NPI number — CITY OF SIOUX CENTER - CITY TREASURER

Table of content: DARRICK POTTER JR. MD (NPI 1831753854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770643132 NPI number — CITY OF SIOUX CENTER - CITY TREASURER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SIOUX CENTER - CITY TREASURER
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:
1770643132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
341 NORTH MAIN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX CENTER
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51250-0313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-722-2453
Provider Business Mailing Address Fax Number:
712-722-2495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
341 NORTH MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX CENTER
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51250-0313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-722-2453
Provider Business Practice Location Address Fax Number:
712-722-2495
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOOIMA
Authorized Official First Name:
CHAR
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
712-722-2453

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  2840400 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0211482 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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