Provider Demographics
NPI:1659841575
Name:JEFFERSON TOWNSHIP FAYETTE COUNTY
Entity Type:Organization
Organization Name:JEFFERSON TOWNSHIP FAYETTE COUNTY
Other - Org Name:JEFFERSON TOWNSHIP EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:KELLENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-426-6330
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:304-521-1576
Mailing Address - Fax:
Practice Address - Street 1:28 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:43128-1019
Practice Address - Country:US
Practice Address - Phone:513-335-0215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport