Provider Demographics
NPI:1740482629
Name:TOWNSHIP OF CLARK BOARD OF TRUSTEES
Entity type:Organization
Organization Name:TOWNSHIP OF CLARK BOARD OF TRUSTEES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-685-4455
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 1:317 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45146
Practice Address - Country:US
Practice Address - Phone:937-685-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000521168OtherANTHEM BCBS
OH2855245Medicaid
OH000000521168OtherANTHEM BCBS