1710072897 NPI number — CITY OF CONNEAUT

Table of content: (NPI 1710072897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710072897 NPI number — CITY OF CONNEAUT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CONNEAUT
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:
1710072897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
294 MAIN ST
Provider Second Line Business Mailing Address:
CONNEAUT RESCUE SQUAD, CITY HALL
Provider Business Mailing Address City Name:
CONNEAUT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44030-2650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-593-7426
Provider Business Mailing Address Fax Number:
440-593-2845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
294 MAIN ST
Provider Second Line Business Practice Location Address:
CONNEAUT RESC SQUAD, CONNEAUT FIRE DEPARTMENT
Provider Business Practice Location Address City Name:
CONNEAUT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44030-2650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-593-7426
Provider Business Practice Location Address Fax Number:
440-593-2845
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANFORD
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CITY MANAGER
Authorized Official Telephone Number:
440-593-7401

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: 0150634 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590031274 . This is a "PALMETTO GBA-RAILROAD MED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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