MEDICARE: JEFFERSON TOWNSHIP

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590015315	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000239608	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275525131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON TOWNSHIP

Provider Business Mailing Address
First Line	:	PO BOX 392907
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15251-9900
Country	:	US
Telephone Number	:	800-962-1484
Fax Number	:

Provider Business Practice Location Address
First Line	:	6767 HAVENS CORNERS RD
Second Line	:
City	:	BLACKLICK
State	:	OH
Zip	:	43004-8317
Country	:	US
Telephone Number	:	614-861-3757
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	BRADFORD LYNN SHULL
Credential	:
Telephone Number	:	614-861-3757

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	11/19/2024

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Directions to “JEFFERSON TOWNSHIP ” Practice Location

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