1154414910 NPI number — CROMWELL VOLUNTEER FIRE DEPARTMENT

Table of content: (NPI 1154414910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154414910 NPI number — CROMWELL VOLUNTEER FIRE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROMWELL VOLUNTEER FIRE DEPARTMENT
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:
CROMWELL FIRE & AMBULANCE SERVICE
Provider Other Organization Name Type Code:
5
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:
1154414910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35
Provider Second Line Business Mailing Address:
5592 HIGHWAY 210
Provider Business Mailing Address City Name:
CROMWELL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-644-3547
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5592 HIGHWAY 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROMWELL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-644-3547
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROMANOSKI
Authorized Official First Name:
ROXANN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
218-384-9534

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0061 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 222067900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 75166CR . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8181397 . This is a "MEDICA DUAL SOLUTION MSHO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 122197 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8194782 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 172069 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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