=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659841575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFERSON TOWNSHIP FAYETTE COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2018
-----------------------------------------------------
Last Update Date | 09/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28 S MAIN ST
-----------------------------------------------------
City | JEFFERSON TOWNSHIP
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43128-1019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-426-6330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 S MAIN ST
-----------------------------------------------------
City | JEFFERSONVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43128-1019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-426-6330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE EMS CAPTAIN
-----------------------------------------------------
Name | JACOB ROSE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-463-1130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------