Healthcare Provider Details

I. General information

NPI: 1104856194
Provider Name (Legal Business Name): NORTH BALTIMORE VILLAGE OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N. MAIN ST
NORTH BALTIMORE OH
45872-1126
US

IV. Provider business mailing address

205 N. MAIN ST
NORTH BALTIMORE OH
45872-1126
US

V. Phone/Fax

Practice location:
  • Phone: 419-257-2394
  • Fax: 419-257-2457
Mailing address:
  • Phone: 419-257-2394
  • Fax: 419-257-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. KENNETH A YANT
Title or Position: FINANCE OFFICER
Credential:
Phone: 419-257-2394