Provider Demographics
NPI:1275525131
Name:JEFFERSON TOWNSHIP
Entity Type:Organization
Organization Name:JEFFERSON TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOWNSHIP ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-855-4260
Mailing Address - Street 1:PO BOX 73754
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0002
Mailing Address - Country:US
Mailing Address - Phone:937-291-7850
Mailing Address - Fax:937-291-2971
Practice Address - Street 1:6767 HAVENS CORNERS RD
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-8317
Practice Address - Country:US
Practice Address - Phone:614-861-3757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH590015315OtherRAILROAD MEDICARE
OH2363633Medicaid
OH000000239608OtherANTHEM
OH000000239608OtherANTHEM