MEDICARE: PERRY TOWNSHIP LOGAN COUNTY OHIO

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	:	1518168046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRY TOWNSHIP LOGAN COUNTY OHIO

Provider Business Mailing Address
First Line	:	PO BOX 35
Second Line	:
City	:	EAST LIBERTY
State	:	OH
Zip	:	43319-0035
Country	:	US
Telephone Number	:	937-666-3404
Fax Number	:

Provider Business Practice Location Address
First Line	:	3265 STREET STATE
Second Line	:
City	:	EAST LIBERTY
State	:	OH
Zip	:	43319-0035
Country	:	US
Telephone Number	:	937-666-3404
Fax Number	:

Authorized Official
Title or Position	:	CLERK
Name	:	CINDY STALLING
Credential	:
Telephone Number	:	937-666-3415

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	02/15/2013

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Directions to “PERRY TOWNSHIP LOGAN COUNTY OHIO ” Practice Location

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