Provider Demographics
NPI:1164420089
Name:HUNTINGTON TOWNSHIP TRUSTEES
Entity Type:Organization
Organization Name:HUNTINGTON TOWNSHIP TRUSTEES
Other - Org Name:ABERDEEN HUNTINGTON TOWNSHIP VOL. LIFE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-795-0013
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:937-795-0013
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:2164 STATE ROUTE 763
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:OH
Practice Address - Zip Code:45101-9346
Practice Address - Country:US
Practice Address - Phone:800-676-4785
Practice Address - Fax:304-522-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55000103Medicaid
OH202066Medicaid
OH000000494926OtherANTHEM
OH=========001OtherTRICARE
OH202066Medicaid
KY55000103Medicaid
OH202066Medicaid