1013946284 NPI number — VILLAGE OF BELOIT

Table of content: (NPI 1013946284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013946284 NPI number — VILLAGE OF BELOIT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF BELOIT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BELOIT VOL F.D. RESCUE SQUAD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013946284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 276
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELOIT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44609-0276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17893 EAST FIFTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELOIT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-938-9305
Provider Business Practice Location Address Fax Number:
330-938-9305
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARTZELL
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
FISCAL OFFICER
Authorized Official Telephone Number:
330-525-7278

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  020320250 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 590013819 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0475632 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000252909 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com