1457430639 NPI number — MONTVILLE TOWNSHIP TRUSTEES - GEAUGA

Table of content: EMILY SANTOS PT DPT (NPI 1538605316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457430639 NPI number — MONTVILLE TOWNSHIP TRUSTEES - GEAUGA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTVILLE TOWNSHIP TRUSTEES - GEAUGA
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:
Provider Other Organization Name Type Code:
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:
1457430639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 98
Provider Second Line Business Mailing Address:
9755 MADISON ROAD
Provider Business Mailing Address City Name:
MONTVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44064-8731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-968-3784
Provider Business Mailing Address Fax Number:
440-968-3236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9755 MADISON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44064-8731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-968-3784
Provider Business Practice Location Address Fax Number:
440-968-3236
Provider Enumeration Date:
11/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JONOVICH
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
216-387-5722

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  020517150 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000155171 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".