MEDICARE: VILLAGE OF BLOOMDALE

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		OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00259613	OTHER		RAILROAD MEDICARE

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
3	000000156050	OTHER		ANTHEM BLUE CROSS

General Provider Information

NPI Number	:	1982684908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF BLOOMDALE

Provider Business Mailing Address
First Line	:	102 S MAPLE ST
Second Line	:	PO BOX 235
City	:	BLOOMDALE
State	:	OH
Zip	:	44817
Country	:	US
Telephone Number	:	419-454-2941
Fax Number	:	419-454-2119

Provider Business Practice Location Address
First Line	:	102 S MAPLE ST
Second Line	:
City	:	BLOOMDALE
State	:	OH
Zip	:	44817
Country	:	US
Telephone Number	:	419-454-2941
Fax Number	:	419-454-2119

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	WILLIAM JOHN MARECHES
Credential	:
Telephone Number	:	419-454-3764

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	11/15/2023

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Directions to “VILLAGE OF BLOOMDALE ” Practice Location

Language	Start Address	Practice Location

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