Provider Demographics
NPI:1639161326
Name:TOWNSHIP OF GREEN TTEES
Entity type:Organization
Organization Name:TOWNSHIP OF GREEN TTEES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-642-3676
Mailing Address - Street 1:PO BOX 392907
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9907
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:47 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OH
Practice Address - Zip Code:45644
Practice Address - Country:US
Practice Address - Phone:740-642-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000351063OtherANTHEM
OH2534467Medicaid
OH9349051Medicare PIN
OH000000351063OtherANTHEM