Provider Demographics
NPI:1942365481
Name:PLYMOUTH TOWNSHIP TRUSTEES
Entity Type:Organization
Organization Name:PLYMOUTH TOWNSHIP TRUSTEES
Other - Org Name:PLYMOUTH TOWNSHIP FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-993-4350
Mailing Address - Street 1:1001 PLYMOUTH ROAD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-9150
Mailing Address - Country:US
Mailing Address - Phone:440-993-4350
Mailing Address - Fax:440-992-9406
Practice Address - Street 1:1001 PLYMOUTH ROAD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-9150
Practice Address - Country:US
Practice Address - Phone:440-993-4350
Practice Address - Fax:440-992-9406
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLYMOUTH TOWNSHIP TRUSTEES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-26
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020822300341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0232984Medicaid
OH000000156045OtherBCBS
OH590010165OtherRR MEDICARE
OH590010165OtherRR MEDICARE
OH=========00OtherBWC
OHH427530Medicare PIN