=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427121011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NIMISHILLEN TOWNSHIP TRUSTEES STARK COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 01/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4560 BROADWAY AVE
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44641-9370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-453-5880
-----------------------------------------------------
Fax | 330-453-5882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44641-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-453-5880
-----------------------------------------------------
Fax | 330-453-5882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF
-----------------------------------------------------
Name | RICHARD J PETERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-453-5880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 02-0304000
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------