MEDICARE: TOWNSHIP OF BLOOMFIELD

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	022057650	OTHER	OH	TERMINAL-EMS-LIMITED-CATEGORY 3

General Provider Information

NPI Number	:	1871291617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWNSHIP OF BLOOMFIELD

Provider Business Mailing Address
First Line	:	2063 KINSMAN ROAD NW, PO BOX 34
Second Line	:
City	:	NORTH BLOOMFIELD
State	:	OH
Zip	:	44450
Country	:	US
Telephone Number	:	440-685-4734
Fax Number	:

Provider Business Practice Location Address
First Line	:	8870 PARK AVENUE
Second Line	:
City	:	NORTH BLOOMFIELD
State	:	OH
Zip	:	44450-4445
Country	:	US
Telephone Number	:	440-685-4734
Fax Number	:

Authorized Official
Title or Position	:	FISCAL OFFICER
Name	:	FANNIE MILLER
Credential	:
Telephone Number	:	440-685-4734

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	02/21/2023

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Directions to “TOWNSHIP OF BLOOMFIELD ” Practice Location

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