1528269883 NPI number — CITY OF NEWARK

Table of content: (NPI 1528269883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528269883 NPI number — CITY OF NEWARK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF NEWARK
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:
1528269883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2022
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43050-7222
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:
75 S 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43055-5435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-670-7621
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HICKMAN
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
SAFETY DIRECTOR
Authorized Official Telephone Number:
740-349-6750

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: 000000527321 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2763657 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00404673 . This is a "RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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