Provider Demographics
NPI:1649262866
Name:VILLAGE OF LEWISBURG
Entity type:Organization
Organization Name:VILLAGE OF LEWISBURG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SEWERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-962-4640
Mailing Address - Street 1:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45338-0687
Mailing Address - Country:US
Mailing Address - Phone:937-962-4640
Mailing Address - Fax:937-962-4545
Practice Address - Street 1:116 S COMMERCE ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:45338-0697
Practice Address - Country:US
Practice Address - Phone:937-962-4640
Practice Address - Fax:937-962-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0707100341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000217680OtherANTHEM
OH2322436Medicaid
OH590015234OtherRAILROAD MEDICARE
OH2322436Medicaid