Provider Demographics
NPI:1275652661
Name:VILLAGE OF LOUDONVILLE
Entity Type:Organization
Organization Name:VILLAGE OF LOUDONVILLE
Other - Org Name:VILLAGE OF LOUNDONVILLE EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-994-3214
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44842-0150
Mailing Address - Country:US
Mailing Address - Phone:419-994-3214
Mailing Address - Fax:
Practice Address - Street 1:200 N MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:OH
Practice Address - Zip Code:44842-1217
Practice Address - Country:US
Practice Address - Phone:419-994-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE OF LOUDONVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-28
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020524150OtherBOARD OF PHARMACY
OH0940370Medicaid