Provider Demographics
NPI:1417936345
Name:GREEN TWP TRUSTEES
Entity Type:Organization
Organization Name:GREEN TWP TRUSTEES
Other - Org Name:HUSTEAD-GREEN TOWNSHIP EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-605-7591
Mailing Address - Street 1:PO BOX 2065
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-7265
Mailing Address - Country:US
Mailing Address - Phone:866-631-4452
Mailing Address - Fax:937-291-2971
Practice Address - Street 1:6215 SPRINGFIELD XENIA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-8142
Practice Address - Country:US
Practice Address - Phone:937-324-3031
Practice Address - Fax:937-322-4107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02031285013341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000233886OtherANTHEM
OH2393486Medicaid
OH590015540OtherRAILROAD MEDICARE
OH9306701Medicare PIN