Provider Demographics
NPI:1891809018
Name:MADISON TOWNSHIP BD OF TRUSTEES
Entity type:Organization
Organization Name:MADISON TOWNSHIP BD OF TRUSTEES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-678-5167
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:513-527-0659
Practice Address - Street 1:5655 MOSIMAN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-0001
Practice Address - Country:US
Practice Address - Phone:513-424-3384
Practice Address - Fax:513-424-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0353550341600000X
OH02-1623900341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2712372Medicaid
OH000000503811OtherANTHEM
OHP00654167OtherRAILROAD MEDICARE
OH2712372Medicaid
OH=========OtherTRICARE
OH=========-00OtherBWC
OH2712372Medicaid