Healthcare Provider Details

I. General information

NPI: 1992739551
Provider Name (Legal Business Name): WASHINGTON TOWNSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S.S. DAVIS DR.
WEST PORTSMOUTH OH
45663
US

IV. Provider business mailing address

10361 SPARTAN DR
CINCINNATI OH
45215-1220
US

V. Phone/Fax

Practice location:
  • Phone: 740-858-2993
  • Fax:
Mailing address:
  • Phone: 800-962-1484
  • Fax: 513-772-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number020320900
License Number StateOH

VIII. Authorized Official

Name: JEFFREY S BAUER
Title or Position: TRUSTEE
Credential:
Phone: 740-858-2993