Healthcare Provider Details

I. General information

NPI: 1548349574
Provider Name (Legal Business Name): MEAD TOWNSHIP TRUSTEES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 CENTRAL AVE
SHADYSIDE OH
43947-1211
US

IV. Provider business mailing address

59300 LOCKWOOD RUN RD
SHADYSIDE OH
43947-9716
US

V. Phone/Fax

Practice location:
  • Phone: 740-676-9642
  • Fax:
Mailing address:
  • Phone: 740-686-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. DAVID MONTGOMERY
Title or Position: FISCAL OFFICER
Credential:
Phone: 740-686-2381