1811026453 NPI number — VILLAGE OF ROSEVILLE

Table of content: (NPI 1811026453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811026453 NPI number — VILLAGE OF ROSEVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF ROSEVILLE
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:
VILLAGE OF ROSEVILLE VOL FIRE & EMS
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:
1811026453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 392907
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-962-1484
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 W 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-342-9367
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KEYLOR
Authorized Official First Name:
DERICK
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
740-697-7762

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: 000000155272 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0739697 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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