Provider Demographics
NPI:1659841575
Name:JEFFERSON TOWNSHIP FAYETTE COUNTY
Entity type:Organization
Organization Name:JEFFERSON TOWNSHIP FAYETTE COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE EMS CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-463-1130
Mailing Address - Street 1:28 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43128-1019
Mailing Address - Country:US
Mailing Address - Phone:740-426-6330
Mailing Address - Fax:
Practice Address - Street 1:28 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:43128-1019
Practice Address - Country:US
Practice Address - Phone:740-426-6330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport