1174552335 NPI number — CITY OF DRY RIDGE KENTUCKY

Table of content: (NPI 1174552335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174552335 NPI number — CITY OF DRY RIDGE KENTUCKY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF DRY RIDGE KENTUCKY
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:
1174552335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2024
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:
15251-9907
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:
31 BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRY RIDGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-824-9158
Provider Business Practice Location Address Fax Number:
859-824-9160
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STAVE
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS COORDINATOR
Authorized Official Telephone Number:
859-824-9158

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1641 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2546856 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4718020 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590014599 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2443269000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000216660 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4582348 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50001700 . This is a "PASSPORT HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 55000343 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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