1205828902 NPI number — CITY OF MIDDLETOWN

Table of content: (NPI 1205828902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205828902 NPI number — CITY OF MIDDLETOWN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF MIDDLETOWN
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:
1205828902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 634475
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:
45263-4475
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:
1830 YANKEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45044-5941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-425-7996
Provider Business Practice Location Address Fax Number:
513-425-1820
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ZIMMERMAN
Authorized Official First Name:
SAMANTHA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
513-425-7832

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: ========= . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 087672800 . This is a "DEPT. OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "OH BWC" identifier . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000021402 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00149786 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0523982 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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