1396051207 NPI number — CITY OF OLIVETTE

Table of content: (NPI 1396051207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396051207 NPI number — CITY OF OLIVETTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF OLIVETTE
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:
OLIVETTE 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:
1396051207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 28977
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLIVETTE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63132-0977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-424-3701
Provider Business Mailing Address Fax Number:
937-291-2971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9473 OLIVE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLIVETTE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63132-3131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-983-5220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AVERY
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
937-424-3701

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  10336 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00997289 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000000675634 . This is a "ANTHEM" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1396051207 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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