Provider Demographics
NPI:1124015995
Name:VILLAGE OF ST BERNARD
Entity Type:Organization
Organization Name:VILLAGE OF ST BERNARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-242-8474
Mailing Address - Street 1:10361 SPARTAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1220
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:4200 VINE ST
Practice Address - Street 2:
Practice Address - City:SAINT BERNARD
Practice Address - State:OH
Practice Address - Zip Code:45217-1529
Practice Address - Country:US
Practice Address - Phone:513-242-8474
Practice Address - Fax:513-242-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2513015Medicaid
P00199891OtherRR MEDICARE
OH2513015Medicaid
OH2513015Medicaid