MEDICARE: VILLAGE OF GNADENHUTTEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	79-201	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	RR MEDICARE	OTHER	OH	9230021

General Provider Information

NPI Number	:	1003934498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF GNADENHUTTEN

Provider Business Mailing Address
First Line	:	214 W 3RD ST
Second Line	:
City	:	DOVER
State	:	OH
Zip	:	44622-2965
Country	:	US
Telephone Number	:	330-602-5180
Fax Number	:	330-602-5471

Provider Business Practice Location Address
First Line	:	131 N WALNUT ST
Second Line	:
City	:	GNADENHUTTEN
State	:	OH
Zip	:	44629-0155
Country	:	US
Telephone Number	:	740-254-4307
Fax Number	:

Authorized Official
Title or Position	:	CLERK
Name	:	MS. KIM STULL
Credential	:
Telephone Number	:	740-254-4307

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	08/31/2007

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1205259934 — DALLAS WINROD ED.S, NCSP
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Directions to “VILLAGE OF GNADENHUTTEN ” Practice Location

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