=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538169750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF OXFORD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2005
-----------------------------------------------------
Last Update Date | 03/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 217 ELM STREET
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45056-1120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-523-6324
-----------------------------------------------------
Fax | 513-524-7298
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 42426
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45042-0426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-626-9660
-----------------------------------------------------
Fax | 833-953-0588
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF
-----------------------------------------------------
Name | JOHN P. DETHERAGE JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-523-6324
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 02-1916500
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------