Provider Demographics
NPI:1326211251
Name:VILLAGE OF MOWRYSTOWN
Entity Type:Organization
Organization Name:VILLAGE OF MOWRYSTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-442-3818
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-0843
Mailing Address - Country:US
Mailing Address - Phone:937-393-2215
Mailing Address - Fax:937-393-9952
Practice Address - Street 1:50 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MOWRYSTOWN
Practice Address - State:OH
Practice Address - Zip Code:45155-0327
Practice Address - Country:US
Practice Address - Phone:937-393-2215
Practice Address - Fax:937-393-9952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2390541Medicaid
OH2390541Medicaid