1215964101 NPI number — VILLAGE OF BEACH CITY

Table of content: (NPI 1215964101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215964101 NPI number — VILLAGE OF BEACH CITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF BEACH CITY
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:
BEACH CITY FIRE & RESCUE
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:
1215964101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 E. MAIN STREET
Provider Second Line Business Mailing Address:
PO BOX 695
Provider Business Mailing Address City Name:
BEACH CITY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-756-2312
Provider Business Mailing Address Fax Number:
330-756-3199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEACH CITY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44608-9319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-756-2664
Provider Business Practice Location Address Fax Number:
330-756-2058
Provider Enumeration Date:
06/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RENTSCH
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CLERK
Authorized Official Telephone Number:
330-756-2312

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , 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: 000000176108 . This is a "BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 590013867 . This is a "RRMEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2228404 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34144902700 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".