=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508855388
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF SENECA OHIO COUNTY OFFICE OF AUDITOR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2005
-----------------------------------------------------
Last Update Date | 12/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 126 HOPEWELL AVE
-----------------------------------------------------
City | TIFFIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44883-2636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-447-0266
-----------------------------------------------------
Fax | 419-448-5064
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 HOPEWELL AVE
-----------------------------------------------------
City | TIFFIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44883-2636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-447-0266
-----------------------------------------------------
Fax | 419-448-5064
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMS DIRECTOR
-----------------------------------------------------
Name | DONALD E KELBLEY
-----------------------------------------------------
Credential | EMT-P
-----------------------------------------------------
Telephone | 419-447-0266
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------