1912999186 NPI number — CITY OF CLAYTON

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912999186 NPI number — CITY OF CLAYTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CLAYTON
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:
CLAYTON 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:
1912999186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10361 SPARTAN DR
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:
45215-1220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-962-1484
Provider Business Mailing Address Fax Number:
513-772-4464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6996 TAYWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45322-3766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-836-3500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROSE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
937-836-3500

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  02-0329550 , 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: 2280599 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590014777 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000221804 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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