Provider Demographics
NPI:1659368421
Name:GOSHEN TOWNSHIP BOARD OF TRUSTEES
Entity Type:Organization
Organization Name:GOSHEN TOWNSHIP BOARD OF TRUSTEES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-722-3400
Mailing Address - Street 1:10361 SPARTAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1220
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:1849 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:OH
Practice Address - Zip Code:45122-9316
Practice Address - Country:US
Practice Address - Phone:513-722-3473
Practice Address - Fax:513-722-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2068560Medicaid
OH486960001OtherCARESOURCE
OH000000021451OtherANTHEM BCBS
OH590012544OtherRAILROAD MEDICARE
OH=========00OtherBUREAU OF WORKERS COMP
OH000000021451OtherANTHEM BCBS
OH2068560Medicaid
OH2068560Medicaid