Healthcare Provider Details

I. General information

NPI: 1780676395
Provider Name (Legal Business Name): MIFFLIN TOWNSHIP TRUSTEES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 ROCKY FORK BLVD
GAHANNA OH
43230-3336
US

IV. Provider business mailing address

PO BOX 634352
CINCINNATI OH
45263-4352
US

V. Phone/Fax

Practice location:
  • Phone: 614-471-0542
  • Fax:
Mailing address:
  • Phone: 614-471-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number02-0308953
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberFCY.020308951-13
License Number StateOH

VIII. Authorized Official

Name: KENNY KING
Title or Position: EMS DIRECTOR
Credential:
Phone: 614-496-1871