Provider Demographics
NPI:1962587683
Name:VILLAGE OF SHREVE
Entity type:Organization
Organization Name:VILLAGE OF SHREVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-567-2601
Mailing Address - Street 1:150 W. MCCONKEY STREET
Mailing Address - Street 2:PO BOX 604
Mailing Address - City:SHREVE
Mailing Address - State:OH
Mailing Address - Zip Code:44676
Mailing Address - Country:US
Mailing Address - Phone:330-567-2601
Mailing Address - Fax:330-567-3804
Practice Address - Street 1:205 E. MCCONKEY STREET
Practice Address - Street 2:
Practice Address - City:SHREVE
Practice Address - State:OH
Practice Address - Zip Code:44676
Practice Address - Country:US
Practice Address - Phone:330-567-2601
Practice Address - Fax:330-567-3804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE OF SHREVE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-672601341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000182203OtherBCBS
OH590013185OtherRRMEDICARE
OH0353246Medicaid
OH0353246Medicaid