1265433130 NPI number — CITY OF DAYTON

Table of content: (NPI 1265433130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265433130 NPI number — CITY OF DAYTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF DAYTON
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:
1265433130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 632458
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:
45263-2458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-449-8112
Provider Business Mailing Address Fax Number:
888-965-4620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45402-1208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-449-8112
Provider Business Practice Location Address Fax Number:
888-965-4620
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PAYNE
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
937-333-4504

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 590008510 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000021399 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0978330 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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