Provider Demographics
NPI:1043202989
Name:VILLAGE OF NEW LEBANON
Entity Type:Organization
Organization Name:VILLAGE OF NEW LEBANON
Other - Org Name:NEW LEBANON FIRE DEPT.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEYSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-344-4413
Mailing Address - Street 1:PO BOX 110
Mailing Address - Street 2:
Mailing Address - City:NEW LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45345-0110
Mailing Address - Country:US
Mailing Address - Phone:855-626-9660
Mailing Address - Fax:833-953-0588
Practice Address - Street 1:115 S CLAYTON RD
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45345-9601
Practice Address - Country:US
Practice Address - Phone:937-687-7510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
OH0203503003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2328690Medicaid
OH000000214144OtherANTHEM
OH9321971Medicare PIN
OH2328690Medicaid