1528170990 NPI number — CITY OF CANTON

Table of content: (NPI 1528170990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528170990 NPI number — CITY OF CANTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CANTON
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:
CITY OF CANTON FIRE DEPARTMENT
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:
1528170990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9151
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44711-9151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-489-3400
Provider Business Mailing Address Fax Number:
330-471-8831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 7TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44702-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-489-3256
Provider Business Practice Location Address Fax Number:
330-471-8831
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BODNAR
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
CAPTAIN/EMS COORDINATOR
Authorized Official Telephone Number:
330-438-4553

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  020328050 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 590007156 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000155964 . This is a "BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 802689 . This is a "BLACK LUNG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0892486 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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