1750455200 NPI number — CITY OF BERKELEY FIRE DEPT

Table of content: (NPI 1750455200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750455200 NPI number — CITY OF BERKELEY FIRE DEPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BERKELEY FIRE DEPT
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:
1750455200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11914
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94712-2914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-981-5538
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 MARTIN LUTHER KING JR WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94704-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-981-5538
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IMRIE
Authorized Official First Name:
SABINA
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT CHIEF
Authorized Official Telephone Number:
510-981-5502

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ81739Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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