1689663726 NPI number — WAYNE TOWNSHIP BOARD OF TRUSTEES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689663726 NPI number — WAYNE TOWNSHIP BOARD OF TRUSTEES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYNE TOWNSHIP BOARD OF 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:
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:
1689663726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 392907
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15251-9907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-962-1484
Provider Business Mailing Address Fax Number:
513-772-4464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6306 STATE ROUTE 133
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOSHEN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45122-9516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-625-6212
Provider Business Practice Location Address Fax Number:
513-625-6227
Provider Enumeration Date:
10/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BORCHERS
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICARE AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
513-625-6212

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2103039 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 286510001 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000011785 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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