Provider Demographics
NPI:1689919094
Name:CITY OF COUNCIL BLUFFS
Entity Type:Organization
Organization Name:CITY OF COUNCIL BLUFFS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIERKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-328-4666
Mailing Address - Street 1:209 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0826
Mailing Address - Country:US
Mailing Address - Phone:712-328-4666
Mailing Address - Fax:712-328-4917
Practice Address - Street 1:209 PEARL ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0826
Practice Address - Country:US
Practice Address - Phone:712-328-4666
Practice Address - Fax:712-328-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare