Provider Demographics
NPI:1992736631
Name:CITY OF MITCHELLVILLE
Entity type:Organization
Organization Name:CITY OF MITCHELLVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASS. CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TWOHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-967-9324
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50169-0817
Mailing Address - Country:US
Mailing Address - Phone:515-967-9324
Mailing Address - Fax:515-967-2631
Practice Address - Street 1:110 2ND ST. NE
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:IA
Practice Address - Zip Code:50169
Practice Address - Country:US
Practice Address - Phone:515-967-9324
Practice Address - Fax:515-967-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2772700251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0100966Medicaid
IA0100966Medicaid