Provider Demographics
NPI:1134244262
Name:TOWNSHIP OF ATWATER TOWNSHIP TRUSTEES
Entity type:Organization
Organization Name:TOWNSHIP OF ATWATER TOWNSHIP TRUSTEES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-947-2323
Mailing Address - Street 1:6570 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:OH
Mailing Address - Zip Code:44201-9508
Mailing Address - Country:US
Mailing Address - Phone:330-947-2323
Mailing Address - Fax:330-947-1730
Practice Address - Street 1:6570 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:OH
Practice Address - Zip Code:44201-9508
Practice Address - Country:US
Practice Address - Phone:330-947-2323
Practice Address - Fax:330-947-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0468168Medicaid
OHAT9184331Medicare ID - Type Unspecified