NPIMap

Organization Active NPI

Jefferson County

  • Community/Behavioral Health Agency
  • Jefferson, WI
National Provider Identifier
1295864957
Registry record updated Jul 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
2643 Issued in WI
Legal business name
JEFFERSON COUNTY
Practice address
1541 Annex Rd
Jefferson, WI 53549-9803
Phone
(920) 674-3105
Fax
(920) 674-6113
NPI assigned
Mar 5, 2007
Organization subpart
Yes
Parent organization
JEFFERSON COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 10, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel Gebauer, CPA
Title
Deputy Director
Phone
(920) 674-8144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 2643 WI Primary

Addresses

Primary practice location

1541 Annex Rd
Jefferson, WI 53549-9803

Mailing address

1541 Annex Rd
Jefferson, WI 53549-9803
Phone (920) 674-3105

Other identifiers 1

IdentifierTypeStateIssuer
41762700MedicaidWI

Other names 1

  • JEFFERSON COUNTY HUMAN SERVICES-COMPREHENSIVE COMMUNITY SERVICES Other name

National Provider Directory

National Provider Directory
Tax ID family
Jefferson County Health Deparment12 organizations share this tax ID, including this one
Part of
Jefferson County Health Deparment

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215648000000",
    "number": "1295864957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 ANNEX RD",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535499803",
            "telephone_number": "920-674-3105",
            "fax_number": "920-674-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 ANNEX RD",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535499803",
            "telephone_number": "920-674-3105",
            "fax_number": "920-674-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JEFFERSON COUNTY",
        "enumeration_date": "2007-03-05",
        "last_updated": "2008-07-10",
        "status": "A",
        "authorized_official_last_name": "GEBAUER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "DEPUTY DIRECTOR",
        "authorized_official_telephone_number": "920-674-8144",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "2643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41762700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JEFFERSON COUNTY HUMAN SERVICES-COMPREHENSIVE COMMUNITY SERVICES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jefferson, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.