MEDICARE: SHAWNEE TWP BD OF TRUSTEES

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

General Provider Information

NPI Number	:	1265691067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAWNEE TWP BD OF TRUSTEES

Provider Business Mailing Address
First Line	:	2526 FORT AMANDA RD
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-3729
Country	:	US
Telephone Number	:	419-222-2986
Fax Number	:

Provider Business Practice Location Address
First Line	:	2526 FORT AMANDA RD
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-3729
Country	:	US
Telephone Number	:	419-222-2986
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	AUSTIN T MILLER
Credential	:
Telephone Number	:	419-222-2986

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	11/04/2024

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