Provider Demographics
NPI:1104253632
Name:CONCORD TOWNSHIP TRUSTEES
Entity type:Organization
Organization Name:CONCORD TOWNSHIP TRUSTEES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:JUNK
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:740-656-2437
Mailing Address - Street 1:PO BOX 392907
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9907
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:27 W. SPRINGFIELD STREET
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:OH
Practice Address - Zip Code:45628
Practice Address - Country:US
Practice Address - Phone:740-998-5633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0207464503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0098072Medicaid
000000858509OtherANTHEM
=========001OtherMEDICAL MUTUAL
OH0098072Medicaid
=========050OtherCARESOURCE
000000858509OtherANTHEM
=========001OtherMEDICAL MUTUAL