1417936345 NPI number — GREEN TWP TRUSTEES

Table of content: (NPI 1417936345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417936345 NPI number — GREEN TWP TRUSTEES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREEN TWP TRUSTEES
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:
HUSTEAD-GREEN TOWNSHIP EMS
Provider Other Organization Name Type Code:
3
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:
1417936345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2065
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43050-7265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-631-4452
Provider Business Mailing Address Fax Number:
937-291-2971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6215 SPRINGFIELD XENIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45502-8142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-324-3031
Provider Business Practice Location Address Fax Number:
937-322-4107
Provider Enumeration Date:
01/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
FISCAL OFFICER
Authorized Official Telephone Number:
937-605-7591

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  02031285013 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000233886 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2393486 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590015540 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".