Provider Demographics
NPI:1992872022
Name:VILLAGE OF PLYMOUTH
Entity type:Organization
Organization Name:VILLAGE OF PLYMOUTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-687-4331
Mailing Address - Street 1:10361 SPARTAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1220
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:20 PORTNER ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:OH
Practice Address - Zip Code:44865-1209
Practice Address - Country:US
Practice Address - Phone:419-687-5101
Practice Address - Fax:419-687-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0233232Medicaid
590009384OtherRAILROAD MEDICARE
000000499286OtherANTHEM
590009384OtherRAILROAD MEDICARE