1710315395 NPI number — MASSILLON CABLE TV, INC

Table of content: (NPI 1710315395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710315395 NPI number — MASSILLON CABLE TV, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASSILLON CABLE TV, 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:
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:
1710315395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASSILLON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44648-0239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-833-4134
Provider Business Mailing Address Fax Number:
330-809-0222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
814 CABLE CT NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASSILLON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44647-4284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-833-4134
Provider Business Practice Location Address Fax Number:
330-809-0222
Provider Enumeration Date:
10/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LYON
Authorized Official First Name:
GARY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
GM SAFEGUARD
Authorized Official Telephone Number:
330-833-4134

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 312242798 . This is a "MEDICAID PASSPORT PROVIDER - ODA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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