Provider Demographics
NPI:1598058190
Name:JEFFERSON TOWNSHIP TRUSTEES
Entity Type:Organization
Organization Name:JEFFERSON TOWNSHIP TRUSTEES
Other - Org Name:JEFFERSON TWP-BELLVILLE FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-631-9617
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-0356
Mailing Address - Country:US
Mailing Address - Phone:419-886-2111
Mailing Address - Fax:419-886-2142
Practice Address - Street 1:470 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44813-1217
Practice Address - Country:US
Practice Address - Phone:419-886-2111
Practice Address - Fax:419-886-2142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON TOWNSHIP TRUSTEES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-16
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020675850341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020675850OtherBOARD OF PHARMACY
OH0273273Medicaid