Provider Demographics
NPI:1992732960
Name:SULLIVAN TOWNSHIP BOARD OF TRUSTEES
Entity type:Organization
Organization Name:SULLIVAN TOWNSHIP BOARD OF TRUSTEES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-736-2255
Mailing Address - Street 1:500 US HIGHWAY 224
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:OH
Mailing Address - Zip Code:44880-9771
Mailing Address - Country:US
Mailing Address - Phone:330-736-2255
Mailing Address - Fax:
Practice Address - Street 1:500 US HIGHWAY 224
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:OH
Practice Address - Zip Code:44880-9771
Practice Address - Country:US
Practice Address - Phone:419-736-2255
Practice Address - Fax:419-736-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021434800341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000234003OtherBCBS NON-PAR
OH2530970Medicaid
OH021434800OtherBOARD OF PHARMACY
OH=========00OtherBWC
OH9291451Medicare PIN