1982604500 NPI number — CITY OF XENIA

Table of content: (NPI 1982604500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982604500 NPI number — CITY OF XENIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF XENIA
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:
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:
1982604500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2030
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43050-7230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-631-4551
Provider Business Mailing Address Fax Number:
937-291-2971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
XENIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45385-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-376-7280
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MERRIMAN
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CITY MANAGER/SAFETY DIRECTOR
Authorized Official Telephone Number:
937-376-7231

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  02-0299450 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000240254 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2363624 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590015322 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".