MEDICARE: VILLAGE OF POWHATAN POINT

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	020313500	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

General Provider Information

NPI Number	:	1467453175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF POWHATAN POINT

Provider Business Mailing Address
First Line	:	104 MELLOTT ST
Second Line	:
City	:	POWHATAN POINT
State	:	OH
Zip	:	43942-1227
Country	:	US
Telephone Number	:	740-795-4750
Fax Number	:	740-795-4163

Provider Business Practice Location Address
First Line	:	104 MELLOTT ST
Second Line	:
City	:	POWHATAN POINT
State	:	OH
Zip	:	43942-1227
Country	:	US
Telephone Number	:	740-795-4750
Fax Number	:	740-795-4163

Authorized Official
Title or Position	:	ASST CHIEF
Name	:	JAMES P DELMAN
Credential	:
Telephone Number	:	740-795-4750

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	12/15/2023

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