Provider Demographics
NPI:1407839673
Name:CITY OF NORWICH
Entity Type:Organization
Organization Name:CITY OF NORWICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-334-1234
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:31 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1893
Practice Address - Country:US
Practice Address - Phone:607-334-1213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10437341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01778385Medicaid
3200205OtherGHI
590011869OtherPALMETTO GBA-RAILROAD
10030390OtherCDPHP
966193OtherMVP
NY=========OtherBCBS UTICA WATERTOWN
NY01778385Medicaid