Provider Demographics
NPI:1811044779
Name:LIBERTY TOWNSHIP TRUSTEES
Entity Type:Organization
Organization Name:LIBERTY TOWNSHIP TRUSTEES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEERAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-578-0264
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 1:21684 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:OH
Practice Address - Zip Code:43067-0000
Practice Address - Country:US
Practice Address - Phone:937-246-2156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0608408Medicaid
1842455OtherHIGHMARK BS
473887OtherAETNA
22000000297637OtherANTHEM BC
590015613OtherRAILROAD MEDICARE
OH0608408Medicaid
1842455OtherHIGHMARK BS
22000000297637OtherANTHEM BC
=========OtherUNITED HEALTHCARE
=========OtherUNITED HEALTHCARE