1962642520 NPI number — VILLAGE OF MANCHESTER

Table of content: (NPI 1962642520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962642520 NPI number — VILLAGE OF MANCHESTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF MANCHESTER
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:
MANCHESTER FIRE DEPARTMENT AND 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:
1962642520
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2122
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERVIEW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48193-1122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-224-4744
Provider Business Mailing Address Fax Number:
734-479-6319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 E. 5TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-549-3358
Provider Business Practice Location Address Fax Number:
937-549-2502
Provider Enumeration Date:
02/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
STRIBLEN KIRK
Authorized Official First Name:
MARLA
Authorized Official Middle Name:
CHANE
Authorized Official Title or Position:
CAPTAIN
Authorized Official Telephone Number:
513-503-9710

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000622255 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2961595 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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