1073695896 NPI number — ROADRUNNER MOBILITY INC

Table of content: (NPI 1073695896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073695896 NPI number — ROADRUNNER MOBILITY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROADRUNNER MOBILITY INC
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:
Provider Other Organization Name Type Code:
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:
1073695896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39400 TAYLOR PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH RIDGEVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44035-6263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-467-2668
Provider Business Mailing Address Fax Number:
866-362-1367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39400 TAYLOR PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH RIDGEVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44035-6263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-467-2668
Provider Business Practice Location Address Fax Number:
866-362-1367
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROYER
Authorized Official First Name:
DARYL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
800-467-2668

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 146819101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95959 . This is a "PACIFICARE OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 009974800 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 749952024001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90008343 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 531005 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 146818301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200031200A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4582231 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00440883 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1108341 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145445716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200819000A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: N1406 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003135432 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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