1952458465 NPI number — RISER FOODS COMPANY

Table of content: (NPI 1952458465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952458465 NPI number — RISER FOODS COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RISER FOODS COMPANY
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:
1952458465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 KAPPA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15238-2809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-968-1550
Provider Business Mailing Address Fax Number:
412-968-1561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11501 BUCKEYE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44104-3827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-968-1550
Provider Business Practice Location Address Fax Number:
412-968-1561
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRASNOW
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
DIRECTOR OF MANAGED CARE
Authorized Official Telephone Number:
412-968-1550

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  02-1643350 , 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: 2724421 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00419119 . This is a "RRB" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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