Healthcare Provider Details

I. General information

NPI: 1073505897
Provider Name (Legal Business Name): VILLAGE OF PHILLIPSBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 E POPLAR ST
PHILLIPSBURG OH
45354
US

IV. Provider business mailing address

PO BOX 78000 DEPT 781582
DETROIT MI
48278-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-884-7620
  • Fax:
Mailing address:
  • Phone: 866-631-4551
  • Fax: 937-291-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number02-0640550
License Number StateOH

VIII. Authorized Official

Name: JUSTIN SAUNDERS
Title or Position: FIRE CHIEF
Credential:
Phone: 937-884-7620