Provider Demographics
NPI:1891194353
Name:COUNTY OF BLACK HAWK
Entity Type:Organization
Organization Name:COUNTY OF BLACK HAWK
Other - Org Name:BLACK HAWK COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAFISSA
Authorized Official - Middle Name:CISSE
Authorized Official - Last Name:EGBUONYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-291-2413
Mailing Address - Street 1:1407 INDEPENDENCE AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-4396
Mailing Address - Country:US
Mailing Address - Phone:319-291-2413
Mailing Address - Fax:319-291-2418
Practice Address - Street 1:1407 INDEPENDENCE AVE FL 5
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-4396
Practice Address - Country:US
Practice Address - Phone:319-291-2413
Practice Address - Fax:319-291-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251K00000X
363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0108381Medicaid
IA13516Medicare PIN