Provider Demographics
NPI:1366471435
Name:VILLAGE OF PAULDING OHIO
Entity Type:Organization
Organization Name:VILLAGE OF PAULDING OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CLERK
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-399-3311
Mailing Address - Street 1:PO BOX 621005
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45262-1005
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:311 W. WALL ST
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-0000
Practice Address - Country:US
Practice Address - Phone:800-962-1484
Practice Address - Fax:513-772-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0234133Medicaid
OH000000156063OtherANTHEM
OH590175447OtherRAILROAD MEDICARE
OH000000156063OtherANTHEM
OH=========002OtherMEDICAL MUTUAL OF OHIO
OH0234133Medicaid
OH=========002OtherMEDICAL MUTUAL OF OHIO