Provider Demographics
NPI:1295853653
Name:CITY OF NEW CONCORD
Entity Type:Organization
Organization Name:CITY OF NEW CONCORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-826-4986
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:43762-0010
Mailing Address - Country:US
Mailing Address - Phone:740-826-4986
Mailing Address - Fax:740-826-7617
Practice Address - Street 1:2 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CONCORD
Practice Address - State:OH
Practice Address - Zip Code:43762-1219
Practice Address - Country:US
Practice Address - Phone:740-826-4986
Practice Address - Fax:740-826-7617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0741460Medicaid
OH9186021Medicare ID - Type Unspecified