Healthcare Provider Details

I. General information

NPI: 1467596130
Provider Name (Legal Business Name): RUSSELL TWP BOARD OF TRUSTEES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14810 CHILLICOTHE RD
NOVELTY OH
44072-9647
US

IV. Provider business mailing address

PO BOX 21727
CLEVELAND OH
44121-0727
US

V. Phone/Fax

Practice location:
  • Phone: 440-338-8912
  • Fax:
Mailing address:
  • Phone: 440-605-9117
  • Fax: 440-442-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: JOHN FRAZIER
Title or Position: FIRE CHIEF
Credential:
Phone: 440-338-6161