=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073505897
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE OF PHILLIPSBURG
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2005
-----------------------------------------------------
Last Update Date | 12/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 E POPLAR ST
-----------------------------------------------------
City | PHILLIPSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-884-7620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 78000 DEPT 781582
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48278-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-631-4551
-----------------------------------------------------
Fax | 937-291-2971
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | JUSTIN SAUNDERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-884-7620
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 02-0640550
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------