1205953288 NPI number — UNITED COMMUNITIES VOL FIRE DEPT INCORPORATED ROMANCOKE

Table of content: (NPI 1205953288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205953288 NPI number — UNITED COMMUNITIES VOL FIRE DEPT INCORPORATED ROMANCOKE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED COMMUNITIES VOL FIRE DEPT INCORPORATED ROMANCOKE
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:
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:
1205953288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9406 ROMANCOKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEVENSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21666-3616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-643-1162
Provider Business Mailing Address Fax Number:
410-643-1163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9406 ROMANCOKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEVENSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21666-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-643-1162
Provider Business Practice Location Address Fax Number:
410-643-1163
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOSSERT
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-643-1162

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: K600 . This is a "FEDERAL BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 408124200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 920BUN . This is a "CAREFIRST BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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