1023023942 NPI number — RISER FOODS COMPANY

Table of content: (NPI 1023023942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023023942 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:
GIANT EAGLE PHARMACY 224
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:
1023023942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2020
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:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8960 DARROW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWINSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44087-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-405-7105
Provider Business Practice Location Address Fax Number:
330-405-7901
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELMS
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
INSURANCE CONTRACTING & CREDENTIALI
Authorized Official Telephone Number:
412-967-4775

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  021303750 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00419119 . This is a "MEDICARE RAILROAD FLU (RISER) OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2320009 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3670367 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com