1801144191 NPI number — BLOOM TOWNSHIP TRUSTEES

Table of content: (NPI 1801144191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801144191 NPI number — BLOOM TOWNSHIP TRUSTEES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLOOM TOWNSHIP TRUSTEES
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:
BLOOM TOWNSHIP FIRE DEPARTMENT
Provider Other Organization Name Type Code:
3
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:
1801144191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 637897
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-7897
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:
66 S MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITHOPOLIS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43136-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-837-5530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
CLARK
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
614-837-5530

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  020309000-13 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000791961 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P01099993 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0075258 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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