Provider Demographics
NPI:1346340114
Name:TOWNSHIP OF FREEDOM OFFICE OF CLERK
Entity type:Organization
Organization Name:TOWNSHIP OF FREEDOM OFFICE OF CLERK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE/EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-287-4593
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:PEMBERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43450-0836
Mailing Address - Country:US
Mailing Address - Phone:419-287-4626
Mailing Address - Fax:
Practice Address - Street 1:104 E FRONT ST
Practice Address - Street 2:
Practice Address - City:PEMBERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43450-7031
Practice Address - Country:US
Practice Address - Phone:419-287-4626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0819700341600000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0318614Medicaid
OH0318614Medicaid
OH9149541Medicare PIN