Provider Demographics
NPI:1982684908
Name:VILLAGE OF BLOOMDALE
Entity Type:Organization
Organization Name:VILLAGE OF BLOOMDALE
Other - Org Name:VILLAGE OF BLOOMDALE AMBULANCE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MARECHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-454-3764
Mailing Address - Street 1:102 S MAPLE ST
Mailing Address - Street 2:PO BOX 235
Mailing Address - City:BLOOMDALE
Mailing Address - State:OH
Mailing Address - Zip Code:44817
Mailing Address - Country:US
Mailing Address - Phone:419-454-2941
Mailing Address - Fax:419-454-2119
Practice Address - Street 1:102 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:BLOOMDALE
Practice Address - State:OH
Practice Address - Zip Code:44817
Practice Address - Country:US
Practice Address - Phone:419-454-2941
Practice Address - Fax:419-454-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0601969Medicaid
P00259613OtherRAILROAD MEDICARE
000000156050OtherANTHEM BLUE CROSS
OH0601969Medicaid