1457430639 NPI number — MONTVILLE TOWNSHIP TRUSTEES - GEAUGA

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 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".