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Organization
JEFFERSON TOWNSHIP
Active
Organization
JEFFERSON TOWNSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADFORD LYNN SHULL (CHIEF)
(614) 861-3757
Entity
Organization
Contact information
Practice address
6767 HAVENS CORNERS RD, BLACKLICK, OH 43004-8317
(614) 861-3757
Mailing address
PO BOX 392907, PITTSBURGH, PA 15251-9900
(800) 962-1484
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000239608
ANTHEM
OH
05
—
2363633
—
OH
01
—
590015315
RAILROAD MEDICARE
OH
Enumeration date
08/17/2005
Last updated
11/19/2024
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