Provider Demographics
NPI:1700984515
Name:LAKE TWP OFFICE OF CLERK
Entity Type:Organization
Organization Name:LAKE TWP OFFICE OF CLERK
Other - Org Name:LAKE TOWNSHIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BUDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RITSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-838-6536
Mailing Address - Street 1:PO BOX 21727
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-0727
Mailing Address - Country:US
Mailing Address - Phone:440-605-9117
Mailing Address - Fax:440-442-4443
Practice Address - Street 1:27975 CUMMINS RD
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:OH
Practice Address - Zip Code:43447
Practice Address - Country:US
Practice Address - Phone:419-838-6536
Practice Address - Fax:419-838-6732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-1054801341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0418864Medicaid
OHP00086247OtherRR MEDICARE
OH9328451Medicare PIN