Provider Demographics
NPI:1962446641
Name:CLARK TOWNSHIP
Entity type:Organization
Organization Name:CLARK TOWNSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMI
Authorized Official - Middle Name:
Authorized Official - Last Name:YELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-515-3485
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:
Practice Address - Street 1:224 BANK ST.
Practice Address - Street 2:
Practice Address - City:HAMERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45130-0216
Practice Address - Country:US
Practice Address - Phone:937-379-1822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022486150-13341600000X
OH02042785413341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH590013772OtherRAILROAD MEDICARE
OH000000075359OtherANTHEM
OH2179100Medicaid
OH000000075359OtherANTHEM