1033683628 NPI number — CITY OF LONDON

Table of content: (NPI 1033683628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033683628 NPI number — CITY OF LONDON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF LONDON
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:
6
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:
1033683628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX L-3962
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43260-3962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-852-4297
Provider Business Mailing Address Fax Number:
740-852-1392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 E HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43140-1228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-852-4297
Provider Business Practice Location Address Fax Number:
740-852-1392
Provider Enumeration Date:
01/16/2019

Additional Information

Authorized Official

Authorized Official Last Name:
EADES
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
740-852-4297

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0343252 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000001256114 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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