Healthcare Provider Details

I. General information

NPI: 1467584029
Provider Name (Legal Business Name): MONCLOVA TOWNSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4395 ALBON RD
MONCLOVA OH
43542-9346
US

IV. Provider business mailing address

PO BOX 392907
PITTSBURGH PA
15251-9907
US

V. Phone/Fax

Practice location:
  • Phone: 419-865-9423
  • Fax: 419-865-8481
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 Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number02-0533650
License Number StateOH

VIII. Authorized Official

Name: MATTHEW HOMIK
Title or Position: FIRE CHIEF
Credential:
Phone: 419-865-9423