1538169750 NPI number — CITY OF OXFORD

Table of content: (NPI 1538169750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538169750 NPI number — CITY OF OXFORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF OXFORD
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:
1538169750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 42426
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45042-0426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-626-9660
Provider Business Mailing Address Fax Number:
833-953-0588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 ELM STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45056-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-523-6324
Provider Business Practice Location Address Fax Number:
513-524-7298
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DETHERAGE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
513-523-6324

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  02-1916500 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000357359 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2555060 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00209722 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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