Provider Demographics
NPI:1932107687
Name:CITY OF BELLEFONTAINE
Entity Type:Organization
Organization Name:CITY OF BELLEFONTAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE SAFETY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARON
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARMEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-599-6168
Mailing Address - Street 1:201 W SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1417
Mailing Address - Country:US
Mailing Address - Phone:937-599-6168
Mailing Address - Fax:937-592-3988
Practice Address - Street 1:201 W SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1417
Practice Address - Country:US
Practice Address - Phone:937-599-6168
Practice Address - Fax:937-592-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0158190Medicaid
OH0158190Medicaid