Healthcare Provider Details

I. General information

NPI: 1104975929
Provider Name (Legal Business Name): MADISON TWP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 EXPRESSVIEW DR
MANSFIELD OH
44905-1535
US

IV. Provider business mailing address

PO BOX 392907
PITTSBURGH PA
15251-9907
US

V. Phone/Fax

Practice location:
  • Phone: 419-589-5555
  • Fax:
Mailing address:
  • Phone: 800-962-1484
  • Fax: 513-772-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number02-0358700
License Number StateOH

VIII. Authorized Official

Name: DEB SCHEURER
Title or Position: ADMIN ASSISTANT
Credential:
Phone: 419-589-5555