Provider Demographics
NPI:1104856194
Name:NORTH BALTIMORE VILLAGE OFFICE
Entity Type:Organization
Organization Name:NORTH BALTIMORE VILLAGE OFFICE
Other - Org Name:VILLAGE OF NORTH BALTIMORE EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:YANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-257-2394
Mailing Address - Street 1:205 N. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:45872-1126
Mailing Address - Country:US
Mailing Address - Phone:419-257-2394
Mailing Address - Fax:419-257-2457
Practice Address - Street 1:205 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:45872-1126
Practice Address - Country:US
Practice Address - Phone:419-257-2394
Practice Address - Fax:419-257-2457
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH BALTIMORE VILLAGE OFFICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-04
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
OH341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0373402Medicaid
OH0373402Medicaid