1891809018 NPI number — MADISON TOWNSHIP BD OF TRUSTEES

Table of content: (NPI 1891809018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891809018 NPI number — MADISON TOWNSHIP BD OF TRUSTEES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADISON TOWNSHIP BD OF TRUSTEES
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:
MADISON TWP 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:
1891809018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 44736
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45044-0736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-424-0821
Provider Business Mailing Address Fax Number:
513-424-4659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5610 W ALEXANDRIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45042-8928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-424-0821
Provider Business Practice Location Address Fax Number:
513-424-4659
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
JORDAN
Authorized Official Title or Position:
ASSISTANT CHIEF
Authorized Official Telephone Number:
513-678-5167

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  02-0353550 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: 02-1623900 , 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: 2712372 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000503811 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00654167 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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