MEDICARE: CITY OF BELLEFONTAINE

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

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	:	1932107687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF BELLEFONTAINE

Provider Business Mailing Address
First Line	:	201 W SANDUSKY AVE
Second Line	:
City	:	BELLEFONTAINE
State	:	OH
Zip	:	43311-1417
Country	:	US
Telephone Number	:	937-599-6168
Fax Number	:	937-592-3988

Provider Business Practice Location Address
First Line	:	201 W SANDUSKY AVE
Second Line	:
City	:	BELLEFONTAINE
State	:	OH
Zip	:	43311-1417
Country	:	US
Telephone Number	:	937-599-6168
Fax Number	:	937-592-3988

Authorized Official
Title or Position	:	SERVICE SAFETY DIRECTOR
Name	:	GARON C CARMEAN
Credential	:
Telephone Number	:	937-599-6168

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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Directions to “CITY OF BELLEFONTAINE ” Practice Location

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