Provider Demographics
NPI:1679968622
Name:WAYNE TOWNSHIP TRUSTEES TUSCARAWAS COUNTY
Entity type:Organization
Organization Name:WAYNE TOWNSHIP TRUSTEES TUSCARAWAS COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TROYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-852-2835
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:OH
Mailing Address - Zip Code:44624-0126
Mailing Address - Country:US
Mailing Address - Phone:330-852-2835
Mailing Address - Fax:
Practice Address - Street 1:7899 CHERRY RUN ROAD NW
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:OH
Practice Address - Zip Code:44624
Practice Address - Country:US
Practice Address - Phone:330-602-5180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH021002950OtherSTATE OF OHIO PHARMACY LICENSE
OH0139565Medicaid