Provider Demographics
NPI:1023256716
Name:CITY OF MORAINE
Entity type:Organization
Organization Name:CITY OF MORAINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUZMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-535-1141
Mailing Address - Street 1:PO BOX 706419
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45270-6419
Mailing Address - Country:US
Mailing Address - Phone:855-626-9660
Mailing Address - Fax:833-953-0588
Practice Address - Street 1:4747 S DIXIE DR
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-2115
Practice Address - Country:US
Practice Address - Phone:937-535-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0309250341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00820044OtherRAILROAD MEDICARE
OH000000620787OtherANTHEM
OH2953004Medicaid
OHP00820044OtherRAILROAD MEDICARE