1356667174 NPI number — POTTERVILLE FIRE DEPARTMENT INC

Table of content: ELIZABETH ANN BENTSON (NPI 1114672888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356667174 NPI number — POTTERVILLE FIRE DEPARTMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POTTERVILLE FIRE DEPARTMENT INC
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:
1356667174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8879
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02920-0879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-572-3120
Provider Business Mailing Address Fax Number:
401-572-3351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
953 TUNK HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOSTER
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02825-1162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-647-3505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GREENWAY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
401-647-3505

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  66 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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