MEDICARE: JEFFERSON TOWNSHIP 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	341600000X	Ambulance

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

General Provider Information

NPI Number	:	1275742439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON TOWNSHIP BD OF TRUSTEES

Provider Business Mailing Address
First Line	:	PO BOX 633027
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0031
Country	:	US
Telephone Number	:	937-262-3580
Fax Number	:	937-262-3599

Provider Business Practice Location Address
First Line	:	ONE BUSINESS PARK DRIVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45427
Country	:	US
Telephone Number	:	937-262-3580
Fax Number	:	937-262-3599

Authorized Official
Title or Position	:	CHIEF
Name	:	MR. ROY MANN
Credential	:
Telephone Number	:	937-262-3580

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	04/19/2012

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