Provider Demographics
NPI:1972505337
Name:BEAVERCREEK TOWNSHIP
Entity Type:Organization
Organization Name:BEAVERCREEK TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANDENBOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-426-1213
Mailing Address - Street 1:PO BOX 706388
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45270-6388
Mailing Address - Country:US
Mailing Address - Phone:866-631-3116
Mailing Address - Fax:
Practice Address - Street 1:851 ORCHARD LANE
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-7228
Practice Address - Country:US
Practice Address - Phone:937-426-1213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0302250341600000X
OH341600000X
OHFCY.020302250-13341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000208191OtherANTHEM
OH2239429Medicaid
OH590014586OtherRAILROAD MEDICARE
OH000000208191OtherANTHEM
OH2239429Medicaid