Provider Demographics
NPI:1154483204
Name:CHAMPION TOWNSHIP TRUSTEES
Entity Type:Organization
Organization Name:CHAMPION TOWNSHIP TRUSTEES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-847-0311
Mailing Address - Street 1:10361 SPARTAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1220
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:139 CHAMPION AVE W
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1413
Practice Address - Country:US
Practice Address - Phone:330-847-0311
Practice Address - Fax:330-847-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1550207Medicaid
OH000000176195Medicaid
OH0527782Medicaid
000000155967OtherANTHEM
913071300OtherACS
913071300OtherACS
OH=========-00OtherWORKERS COMP
=========-007OtherMEDICAL MUTUAL
OH=========-00OtherWORKERS COMP