MEDICARE: COLUMBIA 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	341600000X	Ambulance

General Provider Information

NPI Number	:	1477702389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA TOWNSHIP

Provider Business Mailing Address
First Line	:	PO BOX 621005
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45262-1005
Country	:	US
Telephone Number	:	800-962-1484
Fax Number	:	513-772-4464

Provider Business Practice Location Address
First Line	:	29446 STATE ROUTE 143
Second Line	:
City	:	ALBANY
State	:	OH
Zip	:	45710
Country	:	US
Telephone Number	:	740-698-0302
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	REX CHEADLE
Credential	:
Telephone Number	:	740-698-0302

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	09/16/2008

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Directions to “COLUMBIA TOWNSHIP ” Practice Location

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