Basic Information
| Provider Information | |||||||||
| NPI: | 1659841575 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JEFFERSON TOWNSHIP FAYETTE COUNTY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | JEFFERSON TOWNSHIP EMS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045211576 | ||||||||
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| Practice Location | |||||||||
| Address1: | 28 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON TOWNSHIP | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431281019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133350215 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2018 | ||||||||
| LastUpdateDate: | 07/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | KELLENBERGER | ||||||||
| AuthorizedOfficialFirstName: | DANA | ||||||||
| AuthorizedOfficialMiddleName: | LESLIE | ||||||||
| AuthorizedOfficialTitleorPosition: | EMS CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 7404266330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
No ID Information.