Healthcare Provider Details

I. General information

NPI: 1992732960
Provider Name (Legal Business Name): SULLIVAN TOWNSHIP BOARD OF TRUSTEES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 US HIGHWAY 224
SULLIVAN OH
44880-9771
US

IV. Provider business mailing address

500 US HIGHWAY 224
SULLIVAN OH
44880-9771
US

V. Phone/Fax

Practice location:
  • Phone: 419-736-2255
  • Fax: 419-736-2266
Mailing address:
  • Phone: 330-736-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number021434800
License Number StateOH

VIII. Authorized Official

Name: DOUGLAS W CAMPBELL
Title or Position: CHIEF
Credential:
Phone: 419-736-2255