Provider Demographics
NPI:1558359166
Name:VILLAGE OF WESTON OHIO
Entity type:Organization
Organization Name:VILLAGE OF WESTON OHIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-669-3224
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:419-669-0501
Practice Address - Street 1:20761 TAYLOR ST.
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:OH
Practice Address - Zip Code:43569
Practice Address - Country:US
Practice Address - Phone:419-669-3723
Practice Address - Fax:419-669-8046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0510049Medicaid
OH000000156079OtherANTHEM BLUE CROSS
OH000000156079OtherANTHEM BLUE CROSS
OH0510049Medicaid