MEDICARE: RIVERSIDE FIRE DEPARTMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000021566	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295737658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	PO BOX 712189
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45271-0001
Country	:	US
Telephone Number	:	937-619-3013
Fax Number	:	937-619-3014

Provider Business Practice Location Address
First Line	:	1791 HARSHMAN RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-5017
Country	:	US
Telephone Number	:	937-258-6460
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	DAN ALIG
Credential	:
Telephone Number	:	937-258-6460

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	08/22/2020

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Directions to “RIVERSIDE FIRE DEPARTMENT ” Practice Location

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