Healthcare Provider Details

I. General information

NPI: 1700984515
Provider Name (Legal Business Name): LAKE TWP OFFICE OF CLERK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27975 CUMMINS RD
MILLBURY OH
43447
US

IV. Provider business mailing address

PO BOX 21727
CLEVELAND OH
44121-0727
US

V. Phone/Fax

Practice location:
  • Phone: 419-838-6536
  • Fax: 419-838-6732
Mailing address:
  • Phone: 440-605-9117
  • Fax: 440-442-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number02-1054801
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: BUDDY RITSON
Title or Position: FISCAL OFFICER
Credential:
Phone: 419-838-6536