=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174880850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRANVILLE TOWNSHIP TRUSTEES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2012
-----------------------------------------------------
Last Update Date | 10/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 S. MAIN STREET
-----------------------------------------------------
City | GRANVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-587-0261
-----------------------------------------------------
Fax | 740-587-1362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 231
-----------------------------------------------------
City | GRANVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43023-0231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-587-0261
-----------------------------------------------------
Fax | 740-587-1362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | CASEY CURTIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-587-0261
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | EMS.021648200
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------