Provider Demographics
NPI:1992923999
Name:JEFFERSON TOWNSHIP FIRE DEPARTMENT
Entity type:Organization
Organization Name:JEFFERSON TOWNSHIP FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:937-262-3580
Mailing Address - Street 1:1 BUSINESS PARK DR.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45427
Mailing Address - Country:US
Mailing Address - Phone:937-262-3580
Mailing Address - Fax:837-262-3022
Practice Address - Street 1:1 BUSINESS PK
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45427
Practice Address - Country:US
Practice Address - Phone:937-262-3580
Practice Address - Fax:837-262-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0858791Medicaid
OH31000581-00OtherWORKERS COMP
OH0858791Medicaid
OHJE9219201Medicare ID - Type Unspecified