1396752317 NPI number — RISER FOODS COMPANY

Table of content: (NPI 1396752317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396752317 NPI number — RISER FOODS COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RISER FOODS COMPANY
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:
1396752317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 KAPPA DR
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:
15238-2809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6079 ANDREWS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENTOR ON THE LAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44060-2821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-306-0011
Provider Business Practice Location Address Fax Number:
440-306-0022
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRASNOW
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR MANAGED CARE
Authorized Official Telephone Number:
412-968-1550

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  021374850 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00419119 . This is a "MEDICARE RAILROAD FLU RISER OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2426815 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3671333 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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