1215929823 NPI number — SRWW JOINT FIRE DISTRICT 2

Table of content: (NPI 1215929823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215929823 NPI number — SRWW JOINT FIRE DISTRICT 2

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SRWW JOINT FIRE DISTRICT 2
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:
Provider Other Organization Name Type Code:
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:
1215929823
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10361 SPARTAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45215-1220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-962-1484
Provider Business Mailing Address Fax Number:
513-772-4464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 S JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SABINA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45169-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-584-4132
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GASKINS
Authorized Official First Name:
CHUCK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
937-584-4132

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  020326750 , 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: 000000350734 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2545606 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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