Provider Demographics
NPI:1457430639
Name:MONTVILLE TOWNSHIP TRUSTEES - GEAUGA
Entity Type:Organization
Organization Name:MONTVILLE TOWNSHIP TRUSTEES - GEAUGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:JONOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-387-5722
Mailing Address - Street 1:P.O. BOX 98
Mailing Address - Street 2:9755 MADISON ROAD
Mailing Address - City:MONTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44064-8731
Mailing Address - Country:US
Mailing Address - Phone:440-968-3784
Mailing Address - Fax:440-968-3236
Practice Address - Street 1:9755 MADISON RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44064-8731
Practice Address - Country:US
Practice Address - Phone:440-968-3784
Practice Address - Fax:440-968-3236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020517150341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000155171OtherBLUE CROSS BLUE SHIELD
OH9307801Medicare ID - Type Unspecified
OH9307802Medicare PIN