MEDICARE: CITY OF RIVERSIDE

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	3416L0300X	Land Ambulance
2	341600000X	Ambulance	FCY.020328700-13	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590009041	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590009041	OTHER	OH	RAILROAD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	ANTHEM	OTHER	OH	000000021566

General Provider Information

NPI Number	:	1922097427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF RIVERSIDE

Provider Business Mailing Address
First Line	:	PO BOX 73648
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0002
Country	:	US
Telephone Number	:	800-962-1484
Fax Number	:	513-527-0659

Provider Business Practice Location Address
First Line	:	1791 HARSHMAN RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-5017
Country	:	US
Telephone Number	:	937-233-6212
Fax Number	:	937-252-8052

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MARK MILLER
Credential	:
Telephone Number	:	937-233-6265

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	04/16/2026

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Directions to “CITY OF RIVERSIDE ” Practice Location

Language	Start Address	Practice Location

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