Healthcare Provider Details

I. General information

NPI: 1306988357
Provider Name (Legal Business Name): VILLAGE OF SHERRODSVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SHERROD AVE
SHERRODSVILLE OH
44675
US

IV. Provider business mailing address

PO BOX 31
SHERRODSVILLE OH
44675-0031
US

V. Phone/Fax

Practice location:
  • Phone: 740-269-5025
  • Fax:
Mailing address:
  • Phone: 740-269-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number021016900
License Number StateOH

VIII. Authorized Official

Name: MS. ROXANNE MAZUR
Title or Position: FISCAL OFFICER
Credential:
Phone: 740-269-5025