MEDICARE: JEFFERSON TOWNSHIP FIRE DEPARTMENT

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		OH

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
2	31000581-00	OTHER	OH	WORKERS COMP

General Provider Information

NPI Number	:	1992923999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON TOWNSHIP FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	1 BUSINESS PARK DR.
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45427
Country	:	US
Telephone Number	:	937-262-3580
Fax Number	:	837-262-3022

Provider Business Practice Location Address
First Line	:	1 BUSINESS PK
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45427
Country	:	US
Telephone Number	:	937-262-3580
Fax Number	:	837-262-3022

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	ROY R MANN SR.
Credential	:
Telephone Number	:	937-262-3580

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	08/22/2020

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